Bolus is bogus.

By now we’re all familiar with the saga of re-examining the absolute benefit of adjuvant radiation treatments with increasingly effective systemic therapies. Before we go so far as to eliminate a treatment altogether, perhaps we should examine the small things we add for that small incremental benefit at the cost of incremental toxicity. That’s right, this contemporary study evaluates the benefit of adding bolus during post-mastectomy radiation (PMRT). It’s a retrospective look at 1887 patients receiving PMRT at a Vancouver center, with 318 patients (17%) not receiving bolus per physician preference, almost exclusively in the setting of reconstruction. Sure, there could be selection bias, but local failure was <2% regardless of bolus, and multivariate analysis showed bolus was associated with neither local control nor breast cancer mortality. TBL: Any tiny absolute benefit of bolus during PMRT without known skin involvement in the setting of contemporary systemic therapy may not be worth its tried and true toxicity. | Nichol, Int J Radiat Oncol Biol Phy 2020

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