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Development of a practice-based score to predict extended duration of proton beam therapy session in pediatric
José M Fernández-de Miguel1, Miguel Ángel García-Aroca2, Ignacio Manrique Yera3
1Department of Anaesthesia and Critical Care, Clínica Universidad de Navarra, Madrid, Spain.
Insights
Predicting extended proton beam therapy (PBT) sessions in pediatric patients is now possible. A simple nomogram identifies factors like age and tumor location to optimize PBT planning and improve efficiency.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Proton beam therapy (PBT) is labor-intensive for pediatric patients.
- Optimizing PBT operational efficiency is crucial for quality and safety.
- Predictive models can aid in resource allocation and treatment planning.
Purpose of the Study:
- To identify patient-specific factors influencing pediatric PBT session duration.
- To develop a predictive score for extended PBT sessions in children.
- To enhance the efficiency and safety of pediatric PBT protocols.
Main Methods:
- Observational retrospective cohort study (May 2020 - Feb 2024).
- Recruited 77 ASA III pediatric patients undergoing PBT.
- Developed a nomogram-based predictive score using multivariable analysis.
Main Results:
- Mean PBT session duration was 50 minutes; 51% experienced extended sessions (>45 min).
- Key predictors for extended duration included age >45 months, long-term venous access, hydrocephalus, and craniospinal tumor location.
- The five-variable nomogram achieved an AUC of 0.84 for predicting extended duration.
Conclusions:
- A straightforward nomogram utilizing pre-treatment data can predict extended pediatric PBT duration.
- This tool has the potential to refine clinical practice and improve PBT planning.
- Facilitates better operational efficiency and resource management in pediatric PBT.
Purpose:
Due to the labor intensity demanded by proton beam therapy (PBT) in pediatric patients, information on operational procedures related to efficiency is crucial to optimize quality and safety. We aimed to identify patient factors that affect the duration of the pediatric PBT session and to develop an easy-to-use predictive score of extended duration.
Methods/Patients:
This is an observational retrospective cohort study in an academic medical centre, between May 2020 and February 2024. Seventy seven ASA III pediatric patients treated with PBT were recruited.
Results:
The mean age was 4.8 years [standard deviation (SD): 2.1] and 52% were women. The mean duration of the PBT session was 50 min (SD: 17). Extended duration of the PBT session (> 45 min) occurred in 39 patients (51%). Five predictors of extended duration were selected for the final prediction model. In the multivariable model, an age > 45 months showed a near eightfold increased odds of extended duration [Odds ratio (OR): 7.76, 95% confidence interval (95% CI) 1.63-36.99, P = 0.010]. The OR (95% CI) for long-term venous access, no recurrent tumors, hydrocephalus, and craniospinal location were 5.91 (1.47 to 23.79), 3.81 (0.67 to 21.69), 3.79 (0.90 to 15.97), and 2.59 (0.69 to 9.76), respectively. This five-variable model was used to build a nomogram-based score with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.76-0.93).
Conclusions:
A simple nomogram based on readily available pretreatment data has potential for planning pediatric PBT standard clinical expert practice.
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