Abstract
Conventional methods that have been developed to immobilize the mouth and tongue for radiotherapy (RT) in head and neck cancer (HNC) treatment have been unsatisfactory. We, therefore, developed three-dimensional (3D), customizable, silicone bite blocks and examined their clinical feasibility. For HNC patients, before RT, the 3D printed bite blocks were fabricated based on primary computed tomography (CT) simulation images. The placement of the 3D bite blocks was followed by a secondary CT simulation before RT planning was finalized. Dosimetric parameters and positioning verification achieved with the propose bite blocks were compared with conventional universal oral corks. The 3D printed bite blocks were conformal to the occlusal surface, ensuring immobilization of the tongue without eliciting a gag reflex, and an elastic and firm texture that supports opening of the mouth, with a smooth surface with tolerable intraoral tactility. The dosimetry of patients using the proposed bite blocks showed better coverage of the planning target volume and surface of a tumour bed along with reduction in normal tissue doses. Good concordance of positioning by 3D printed bite blocks during the RT course was verified. The 3D printed bite blocks with silicone might be a customizable, safe, and practical advanced technology in RT for HNC.
Highlights
Head and neck cancer (HNC) is one of the most common malignancies worldwide
Images; third, the digital imaging and communications in medicine (DICOM) images were translated into blueprints with the occlusal surface and tongue contoured, and the blueprints were checked by radiation oncologists; fourth, 3D printing with silicone proceeded according to the blueprints; fifth, secondary computed tomography (CT) simulation with silicone 3D printed bite blocks was carried out; sixth, RT planning and dosimetry with silicone 3D printed bite blocks was reviewed before treatment; seventh, the patient positioning verification was checked by port film imaging
We fabricated the 3D printed bite blocks with silicone, an elastic but firm, strong, durable, and safe material. These 3D printed bite blocks were manufactured by the silicone 3D printer
Summary
Head and neck cancer (HNC) is one of the most common malignancies worldwide. Approximately650,000 patients are diagnosed annually with HNC worldwide [1]. Head and neck cancer (HNC) is one of the most common malignancies worldwide. 650,000 patients are diagnosed annually with HNC worldwide [1]. Most HNCs arise in the epithelial lining of the oral cavity, oropharynx, larynx, and hypopharynx. They share similar risk factors, including cigarette smoking and alcohol drinking [2].
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