Anesthesia in Pediatric Radiotherapy: A Systematic Literature Review by the SIOP Europe Working Group on Pediatric...

Area of Science:

• Pediatric Oncology
• Anesthesiology
• Radiation Therapy

Background:

• Radiotherapy (RT) is a cornerstone of pediatric cancer treatment, necessitating patient immobility.
• Sedation and general anesthesia (GA) are commonly used for immobility in pediatric RT, particularly in younger or non-compliant children.
• Concerns exist regarding acute complications and potential long-term neurodevelopmental effects associated with anesthesia in this population.

Purpose of the Study:

• To systematically review the literature on sedation and general anesthesia (GA) practices in pediatric radiation therapy (RT).
• To identify current anesthetic techniques, safety profiles, and complication rates.
• To inform the development of standardized practice recommendations for pediatric RT anesthesia.

Main Methods:

• A systematic literature review was conducted following PRISMA guidelines, searching Medline and Embase databases (March-September 2024).
• Thirty-nine studies focusing on sedation and GA in pediatric RT were included.
• Data on anesthetic techniques, staffing, monitoring, and complications were extracted and analyzed, noting study quality and heterogeneity.

Main Results:

• Propofol-based sedation was the most frequently reported technique, demonstrating favorable safety when administered by experienced pediatric anesthetists.
• Significant heterogeneity was observed in anesthetic techniques, staffing, and monitoring across studies.
• Complication rates were highly variable and often poorly defined, with additional concerns regarding long-term neurocognitive impact and procedural burden.

Conclusions:

• Current evidence suggests that sedation and GA can be used safely in pediatric RT.
• However, the existing literature is limited, inconsistent, and predominantly consists of low-to-moderate quality retrospective studies.
• There is an urgent need for standardized protocols and prospective research to better define safety, long-term outcomes, and optimal staffing for pediatric RT anesthesia.