Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
Radiother Oncol. 2024 Jul;196:110314. doi: 10.1016/j.radonc.2024.110314. Epub 2024 Apr 25.
To compare patient discomfort and immobilisation performance of open-face and closed immobilization masks in cranial radiotherapy.
This was a single-center randomized self-controlled clinical trial. At CT simulation, an open-face and closed mask was made for each patient and treatment plans with identical dose prescription were generated for each mask. Patients were randomised to start treatment with an open-face or closed mask. Masks were switched halfway through the treatment course; every patient was their own control. Patients self-reported discomfort, anxiety and pain using the visual analogue scale (VAS). Inter- and intrafraction set-up variability was measured with planar kV imaging and a surface guided radiotherapy (SGRT) system for the open-face masks.
30 patients with primary or metastatic brain tumors were randomized - 29 completed radiotherapy to a median total dose of 54 Gy (range 30-60 Gy). Mean discomfort VAS score was significantly lower with open-face masks (0.5, standard deviation 1.0) vs. closed masks (3.3, standard deviation 2.9), P < 0.0001. Anxiety and pain VAS scores were significantly lower with open-face masks (P < 0.0001). Closed masks caused more discomfort in infraorbital (P < 0.001) and maxillary (P = 0.02) areas. Two patients and 27 patients preferred closed or open-face masks, respectively. Interfraction longitudinal shifts and roll and yaw rotations were significantly smaller and lateral shifts were significantly larger with closed masks in combination with the laser system (P < 0.05) compared to open masks in combination with a SGRT system. Intrafraction variability did not differ between the masks.
Open-face masks are associated with decreased patient discomfort without compromising patient positioning and immobilisation accuracy.
比较颅部放射治疗中开放式和封闭式面罩的患者不适和固定效果。
这是一项单中心随机自身对照临床试验。在 CT 模拟时，为每位患者制作了开放式和封闭式面罩，并为每个面罩生成了相同剂量处方的治疗计划。患者随机选择开始使用开放式或封闭式面罩进行治疗。治疗过程中中途更换面罩；每位患者均为自己的对照。患者使用视觉模拟量表（VAS）自行报告不适、焦虑和疼痛。开放式面罩采用平面千伏成像和表面引导放疗（SGRT）系统测量了分次内和分次间的摆位变异性。
30 名原发性或转移性脑肿瘤患者被随机分组 - 29 名患者完成了中位数总剂量为 54 Gy（范围 30-60 Gy）的放射治疗。开放式面罩的平均不适 VAS 评分明显低于封闭式面罩（0.5，标准差 1.0）vs. 3.3，标准差 2.9），P < 0.0001。开放式面罩的焦虑和疼痛 VAS 评分明显较低（P < 0.0001）。封闭式面罩在眶下（P < 0.001）和上颌（P = 0.02）区域引起更多不适。两名患者和 27 名患者分别更喜欢封闭式或开放式面罩。与开放式面罩联合 SGRT 系统相比，在与激光系统联合使用时，封闭式面罩的分次间纵向移位和滚动及偏航旋转明显较小，侧向移位明显较大（P < 0.05）。分次内变异性在两种面罩之间没有差异。
开放式面罩可降低患者的不适，同时不影响患者的定位和固定精度。
