Investigation of the effect of bolus on skin dose in breast cancer treatment with tomotherapy and LINAC radiotherapy devices

In postmastectomy radiation therapy (PMRT), it is important that the chest wall skin is included in the target volume and receives an adequate dose. This study aims to investigate the effect of bolus on skin dose in breast cancer treatment with Tomotherapy and LINAC radiotherapy devices and to examine the accuracy of the surface dose calculated by treatment planning system (TPS) with thermoluminescence dosimetry (TLD). Female Alderson Rando Phantom's chest wall is virtually divided into 9 regions. Computed tomography (CT) images of the phantom were obtained with a section thickness of 3 mm. Two plans, with and without bolus, were created for each of the helical tomotherapy (HT), intensity-modulated radiotherapy (IMRT) and field-in-field (FiF) techniques. A bolus thickness of 0.5 cm was used for all bolus plans. Doses calculated from TPSs were obtained for 88 predetermined points on the chest wall. After irradiation, doses measured with TLDs were obtained. The effect of bolus use on the chest wall surface was examined. The increase in surface dose due to bolus use was 50.35%, 55.35% and 68.56% for HT, IMRT and FiF techniques in TPS, respectively. This increase in TLD measurements was 58.18%, 30.90% and 46.31% for HT, IMRT and FiF techniques, respectively. The best agreement between TPS and TLD doses for bolus and non-bolus plans was found in the HT technique. The difference between TPS and TLD doses decreased within the three treatment techniques due to bolus use. Since the chest wall skin cannot receive the required dose in IMRT and FiF techniques, bolus use is recommended until acute skin reactions occur. There is no need to use a bolus for the HT technique.