%0 Journal Article
%T Randomized self-controlled study comparing open-face vs. closed immobilization masks in fractionated cranial radiotherapy.
%A Keane M
%A Weitkamp N
%A Madani I
%A Day J
%A Dal Bello R
%A Zamburlini M
%A Schiess A
%A Moreira A
%A Perryck S
%A Tomuschat K
%A Spencer M
%A Tanadini-Lang S
%A Guckenberger M
%A Brown M
%J Radiother Oncol
%V 196
%N 0
%D 2024 Jul 25
%M 38677329
%F 6.901
%R 10.1016/j.radonc.2024.110314
%X <B>OBJECTIVE: </B>To compare patient discomfort and immobilisation performance of open-face and closed immobilization masks in cranial radiotherapy.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Open-face masks are associated with decreased patient discomfort without compromising patient positioning and immobilisation accuracy.