Research Organization Document

Section 1:

Problem that needs to be solved: Bolus is a useful tool when treating various forms of cancer.
This paper intends to study the efficacy and subsequent effects of using 5 mm of bolus qod vs. 3
mm of bolus qd.

Key questions that need to be answered:

- How does the difference between 5mm of bolus qod and 3 mm of bolus qd effect the
dose distribution in the patient?
- What were the resulting skin reactions to both treatment methods?
o Did one technique cause significantly worse skin effects than the other?

Evidence of a gap in the literature:

Bolus is frequently utilized in radiation treatments to bring the prescribed dose closer to
the patient’s skin. There are many techniques as it relates to the deployment of bolus. Our paper
will analyze the differences between using 5mm of bolus every other day and 3 mm of bolus
every day. Based upon this group’s preliminary research, no such article currently exists. We
will delve into the dose distribution and resulting skin reactions of both techniques. There are
articles that examine 5mm of bolus and no bolus.1 There are also articles that compare different
types of bolus.2 Our group also found multiple articles cover general information regarding skin
reactions.3,4,5,6,7 However, as previously mentioned, none of these articles examine the questions
our paper aims to answer. We believe this sufficiently demonstrates a “gap in the literature” and
a subsequent need for an article, such as ours, to exist.

References to support your research:

1. Lucas Gomes Sapienza. Clinical trial of the use of bolus in post mastectomy irradiation in
breast cancer. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01925651.
Published 2013. Accessed May 23, 2018.
 2. Humphries S, Boyd K, Cornish P, & Newman F. Comparison of super stuff and paraffin
wax bolus in radiation therapy of irregular surfaces. Med Dos. 1996; 21(3): 155-157.
https://doi.org/10.1016/0958-3947(96)00076-3
3. Wang Y, Park J. (2015, April 30) Evaluation of the chest wall skin dose associated with
bolus application in postmastectomy radiation therapy (PMRT) using nanodot OSLD.
Oncology, (29)4_Suppl_1,132. Retrived from http://www.cancernetwork.com/ars-
2015/p132-evaluation-chest-wall-skin-dose-associated-bolus-application-
postmastectomy-radiation-therapy
4. Pignol JP, Vu TT, Mitera G, et al. Prospective evaluation of severe skin toxicity and pain
during postmastectomy radiation therapy. International Journal Radiation Oncology
Biology Physics. 2015; 91(1): 157-164. https://doi.org/10.1016/j.ijrobp.2014.09.022
5. Parekh A, Dholakia A, Zabransky D, et al. Predictors of radiation-induced acute skin
toxicity in breast cancer at a single institution: Role of fractionation and treatment
volume. Advances in Radiation Oncology. 2018; 3(1): 8-15.
https://doi.org/10.1016/j.adro.2017.10.007
6. Asher D, Johnson P, Dogan N, et al. Acute Skin Toxicity is Comparable Between Brass
Bolus and 0.5 Mm Tissue Equivalent Bolus Among Women Receiving Postmastectomy
Irradiation Using Mixed Energy Photons. International Journal Radiation Oncology
Biology Physics. 2017; 99(2): E3. https://doi.org/10.1016/j.ijrobp.2017.06.597
7. Andic F, Ors Y, Davutoglu R, et al. Evaluation of skin dose associated with different
frequencies of bolus applications in post-mastectomy three-dimensional conformal
radiotherapy. J Exp Clin Cancer Res. 2009; 28(1): 41. https://dx.doi.org/10.1186/1756-
9966-28-41

Research Topic:

A comprehensive examination of using 5mm of bolus qod vs. 3 mm of bolus qd

Section Two:

Study Details:

Retrospective

Number of patients: 3 (as of 5/23/18)

 Type of study: Case Study

Roles of each group member:

Group Leader: We’re electing to hold each other accountable and each take on the
role “Group Leader” intermittently throughout this project.

Data Collector(s): Bianca and Amy

Data Analysis: Primary: Jason Secondary: Bianca

Writer: Primary: Dan Secondary: Jason

Editor: Primary: Bianca Secondary: Jason and Amy

Data Collection Approach:

Number of clinical sites for data collection: 2

What information are you interested in: We are interested in comparing the dose distribution and
resulting skin toxicity of using 5mm of bolus every other day and 3mm of bolus every day.

What resources are available for you to use?: We will be using data obtained from Bianca
Tester’s and Amy Cate's clinical site. This data will be in the form of CT datasets and clinical
observations regarding skin toxicity.

Description of your data collection approach: This research paper will take the form of a
retrospective case study. We will be examining as many patients as possible and analyzing their
treatment plans. The CT datasets will be used to observe the dose distribution. The patient’s skin
reactions will be retroactively examined through records taken by the nurses and doctors using
standardized skin check forms (see other attached documents).