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Pediatric radiation with daily anesthesia: A critical analysis of risk, complications, and resources
Aashita1, Abhilash Dagar1, Adrija Ghosh1
1Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Pediatric radiation therapy often requires anesthesia for immobilization, but this increases complication risks, especially in younger children. Efforts should focus on reducing anesthesia needs during pediatric cancer treatment.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Anesthesiology
Background:
- Radiation therapy is vital for pediatric cancer management.
- Advancements necessitate stricter immobilization, posing challenges in pediatric patients.
- Daily anesthesia is often required for pediatric radiation therapy, leading to potential complications.
Purpose of the Study:
- To audit pediatric patients undergoing radiation therapy under anesthesia.
- To highlight associated complications and treatment gaps.
- To provide a roadmap for resource allocation in pediatric radiation oncology.
Main Methods:
- Data collected on pediatric patients requiring radiotherapy under anesthesia.
- Included demographic, tumor, and anesthesia details, plus complications.
- Descriptive, univariate, and multivariate analyses were performed.
Main Results:
- 67 pediatric patients underwent radiotherapy with anesthesia between 2021-2023.
- Anesthesia was needed for 59.12% of sessions; 8.2% of sessions had complications.
- Younger age (<3 years) and full-course anesthesia correlated with increased need and complications.
Conclusions:
- Anesthesia ensures immobilization but carries risks in pediatric radiation therapy.
- Continuous efforts are needed to enable radiation treatment without anesthesia.
- Minimizing anesthesia use can improve safety and treatment compliance in pediatric cancer care.
Introduction:
Radiation therapy plays a crucial role in the management of pediatric cancer. With recent advancements in treatment techniques and radiation delivery, stricter immobilization is required. However, achieving this in pediatric patients is challenging and often necessitates daily anesthesia. In this study, we present an audit of pediatric patients who underwent radiation therapy under anesthesia, highlighting associated complications and providing a roadmap for resource allocation.
Materials And Methods:
We collected data on pediatric patients who required radiotherapy under anesthesia, including demographic details, tumor characteristics, anesthesia specifics, observed complications, and any treatment gaps. Descriptive statistics were used to analyze demographic, tumor, and treatment characteristics. Univariate and multivariate analyses were performed to identify correlations with various variables.
Results:
From January 2021 to December 2023, 67 patients were scheduled for radiotherapy with daily anesthesia. The median age of the patients was 4 years (interquartile range: 2-5 years). Of these, 34 patients required anesthesia for the entire course of treatment, 22 patients needed anesthesia for part of the treatment, and seven patients did not require anesthesia after the simulation. Overall, anesthesia was needed for 59.12% of sessions. Complications occurred in 66 sessions (8.2%) involving 26 patients. Treatment had to be paused in eight cases, with a median delay of 8 days. The treatment compliance rate was 96.9%. An age of <3 years was significantly associated with the need for anesthesia during radiation. The complication rate was notably higher in patients who required anesthesia for the entire course of radiotherapy.
Conclusion:
While the use of anesthesia ensures proper immobilization during radiation treatment for pediatric patients, it carries the risk of complications. Therefore, it is essential to continuously explore and support efforts to allow patients to undergo radiation without the need for anesthesia.
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