Propofol Total Intravenous Anesthesia for Pediatric Proton Radiotherapy and Its Effect on Patient Outcomes.

Area of Science:

• Pediatric Oncology
• Radiation Oncology
• Anesthesiology

Background:

• Patient motion complicates radiotherapy delivery, especially in pediatric proton beam therapy (PBT).
• Children may require up to 30 general anesthesia sessions over 6-8 weeks for PBT.
• The long-term effects of repeated anesthetic exposures in pediatric PBT are not well understood.

Purpose of the Study:

• To evaluate the impact of propofol-based total intravenous anesthesia (TIVA) on overall survival in pediatric PBT.
• To determine the association between propofol-TIVA and unplanned hospital admissions or emergency room visits within 30 days of PBT initiation.

Main Methods:

• Retrospective analysis of pediatric patients (≤19 years) undergoing PBT for central nervous system disease.
• Comparison of outcomes between patients receiving PBT with propofol-TIVA versus those without anesthesia.
• Statistical analysis included Log-rank tests, Cox proportional hazards models, propensity score matching, and E-value analyses.

Main Results:

• Overall survival rates at 1, 2, and 3 years were similar between groups receiving PBT with propofol-TIVA and those without anesthesia (p=0.558).
• Patients receiving propofol-TIVA were younger and had higher rates of treatment interruptions, prior chemotherapy, concurrent chemotherapy, and unplanned admissions/ER visits (p<0.001).
• Multivariable analysis revealed propofol-TIVA was associated with significantly increased odds of unplanned admission/ER visit (OR, 38.311-42.012; p<0.001).

Conclusions:

• Propofol-TIVA during pediatric PBT is not associated with differences in overall survival.
• Pediatric PBT with propofol-TIVA is linked to an elevated risk of unplanned hospitalizations or ER visits within 30 days of treatment commencement.