Abstract
Introduction: Skin cancer is the most prevalent cancer in Iran. While surgical excision is the primary treatment, radiation therapy (RT) plays a crucial role, especially for tumors in critical anatomical locations. This case report evaluates the performance of handmade boluses for skin cancer RT using 6 MV photons. Case Presentation: Two patients with lip squamous cell carcinoma (SCC) and nasal basal cell carcinoma (BCC) were treated using 6 MV photon RT with handmade boluses. Dosimetric evaluation using EBT2 Gafchromic film was performed to verify the delivered radiation doses. For the lip SCC patient, the measured dose was 3.9% higher than the planned 73.85 Gy. For the nasal BCC patient, the measured dose was 3.48% higher than the planned 75.60 Gy, demonstrating the high accuracy of the handmade bolus approach. Discussion: The use of patient-specific, handmade boluses demonstrated several advantages, including reduced air gaps and improved dose delivery accuracy compared to commercial boluses. The consistent bolus positioning minimized interfraction setup variations, leading to lower standard deviations in the measured doses. While this study did not directly quantify the air gap, prior research has reported air gap reductions of over 72% with patient-specific boluses. Conclusion: This case report supports the effectiveness of handmade boluses in combination with 6 MV photons for skin cancer RT, particularly in resource-constrained settings where advanced treatment modalities may not be readily available. The handmade bolus approach provides an accessible solution to enhance the precision of skin cancer RT.