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For external-beam partial breast irradiation, if the CTV lies close to the skin surface, do you apply bolus?

Due to the use of 1-1.5 cm CTV expansions on the surgical bed, the CTV for PBI often closely approaches the skin surface. In such cases, do you apply focal bolus? Does the decision depend on whether you are using 3DCRT or IMRT technique?
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Do you apply bolus for external-beam PBI if the CTV lies close to the skin surface?

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Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on

We do sometimes use bolus if the skin surface is within 1 cm of surgical cavity and also make sure when planning there is flash created to account for inter fraction and intrafraction motion.

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