Clinical Implications of Thermoplastic Mask Immobilization on Acute Effects of Radiotherapy in Head and Neck Cancers

Aim: Thermoplastic immobilization devices are used in head and neck radiotherapy to increase precision of treatment delivery. However, there is concern about increase in radiation induced skin morbidity with the use of such devices. This study was conducted with an aim to evaluate any increase in clinically observed skin reactions with the use of thermoplastic immobilization devices. Materials and methods: Fifty patients of head and neck cancers undergoing radical radiotherapy were randomized into two study groups in this prospective randomized study. Group ‘A’ received treatment with thermoplastic immobilization device. Group‘B’ received treatment without any immobilization device. A weekly assessment of normal tissue reactions was done using Radiation Therapy Oncology Group (RTOG) acute radiation acute radiation morbidity scoring criteria. Results: Increase in skin reactions was seen in patients using thermoplastic devices. Grade 3 reactions were seen in 56 vs 52% in the study and control group respectively. The difference was however not statistically significant (p = 0.09). Conclusion: Increase in skin dose with use of thermoplastic immobilization devices may not clinically translate into a significant increase in acute skin reactions. Thermoplastic immobilization devices can be safely used in head and neck cancers to ensure accurate radiation delivery.