Comparative Efficacy of Mask-Based versus Frame-Based Immobilization in Stereotactic Radiosurgery: A Systematic Review and Meta-Analysis

Introduction: In Stereotactic Radiosurgery (SRS), optimal patient outcomes rely on treatment efficacy and procedural precision, minimizing side effects to the adjacent brain parenchyma. The shift from frame-based (FB) to mask-based (MB) immobilization could mark a new direction in clinical practice, providing a better patient experience. This meta-analysis evaluates treatment time and intrafraction motion, crucial factors in patient comfort and surgical accuracy, comparing FB and MB techniques.

Methods: We rigorously screened 1,380 studies to compare mask-based versus frame-based immobilization in SRS. Adhering to PRISMA guidelines, 15 studies met our inclusion criteria for a focused examination of these methodologies.

Results: Analyzing a total of 1,188 patients, we found mask-based SRS shortens treatment time (Mean Difference [Mask - Frame] = -9.32, 95% CI [-16.22; -2.42], p = 0.24) with minimal heterogeneity (I² = 26%). Conversely, frame-based SRS showed a non-significant edge in controlling intrafraction motion (Standardized Mean Difference favoring Frame, I² = 93%, p < 0.01). Subgroup analyses are ongoing to assess differences for the main conditions treated with SRS.

Conclusion : Our findings indicate a trade-off. Mask-based SRS enhances efficiency, while frame-based SRS could offer better motion management, although without statistical significance. These insights encourage more research comparing both methods, with the goal of providing a patient-centric approach to SRS and refining protocols for better outcomes.