Application of customisable 3D-printed bite blocks combined with nano head, neck and shoulder mask to head and neck neoplasm radiotherapy

Abstract

This study investigated the effectiveness of customisable 3D-printed bite blocks combined with nano head, neck and shoulder mask in radiotherapy for head and neck neoplasms. The images of 50 patients with head and neck neoplasms treated at our hospital from 2020 to 2022 were collected using CBCT. The patients were divided into two groups: 25 in the mask group and 25 in the combination group. The mask group utilized thermoplastic polyurethane (TPU) nanofiber membrane to stabilize the position of the patients’ head, shoulder, and neck. On the other hand, the combined group added a personalized bite block produced by 3D printing technology on the basis of the mask group. Cone beam CT (CBCT) was used to calibrate any errors, and the set-up errors and number of head rotations after image calibration were analyzed between the two groups. The conformation number (CN) and heterogeneity index (HI) in the target area of the intensity-modulated radiation therapy (IMRT) plan of the two groups were calculated, and the dose-volume parameters of the tongue and other organs at risk, including Dmax and Dmean, were compared using paired tests. Follow-up observations were performed to assess the occurrence of adverse reactions to radiation damage among the patients. The findings revealed a statistically significant difference in the Y -axis set-up error between the combination group and the mask group (P < 0.05). Additionally, the combination group exhibited a higher proportion of set-up errors < 2 mm in both the Y -axis and Z-axis directions compared to the mask group. Significantly fewer images showed head rotation in the combination group than in the mask group. In terms of the target area, there were no significant differences observed in the conformation number (CN) and heterogeneity index (HI) between the two groups. However, wearing the personalized bite block resulted in significantly lower Dmax and Dmean values for the tongue. In contrast, the mask group experienced a higher incidence of oral mucositis and taste disorders. By utilizing customizable 3D-printed bite blocks in conjunction with a nano-mask, accurate repositioning for chemotherapy was achieved, leading to a reduction in set-up error and a significant decrease in radiation dose to the tongue and its surface oral mucosa. Consequently, the occurrence of adverse reactions such as oral mucositis and taste disorders was also reduced. The production of personalized bite blocks is simple, with accurate radiotherapy, making it a technique that should be widely adopted.