Randomized trial on two types of thermoplastic masks for patient immobilization during radiation therapy for head-and-neck cancer

Purpose: Radiation therapy for head-and-neck cancer requires a reliable immobilization for an accurate and consistent treatment setup. This prospective, randomized study was done to compare two types of Posicast thermoplastic face masks, in terms of reproducibility, patient comfort, tolerability, and skin damage. Methods and Materials: The patients were randomly assigned to use a head mask (HM) or a head-and-shoulder mask (HSM). Three-dimensional treatment planning was followed by fractionated external-beam radiation therapy. Reproducibility was assessed by comparing port films with simulator films twice during treatment and by comparing actual treatment table positions weekly. Patient tolerability and comfort were studied weekly. The radiation-induced skin damage was assessed every week according to the World Health Organization toxicity scale. Results: A total of 260 patients were included, and 241 (93%) were evaluated. There were no statistically significant differences between the groups (HM or HSM) in terms of reproducibility. Patients using HSM experienced significantly more claustrophobia (p = 0.023). Patients allocated to HSM receiving greater than or equal to60 Gy were found to have more skin reactions. Conclusions: The smaller HM reduced feelings of claustrophobia, as well as skin reactions, for patients receiving greater than or equal to60 Gy. The smaller mask did not compromise the reproducibility of the setup. (C) 2005 Elsevier Inc.