Streamlining Paediatric Palliative Radiotherapy: A Case Study on Reducing Procedural Burden and Avoiding General...

Simulation-free radiotherapy (SF-RT) is a radiotherapy workflow which is growing in use in palliative treatment, allowing for planning on existing diagnostic CT (dCT) scans without the need for a dedicated planning CT (pCT). While this approach is being increasingly adopted in the adult population, its application in paediatric settings has been limited thus far.

We describe the first published report of two paediatric patients treated with SF-RT in a palliative context. Both children had advanced malignancies and were referred for single-fraction radiotherapy for symptom management. In the first case, a 5-year-old child underwent radiotherapy under general anaesthesia (GA) using SF-RT, eliminating the need for an additional GA for CT-Simulation (CT-Sim). In the second case, a 6-year-old child received treatment without GA, supported by other non-anaesthetic pharmacological interventions and surface guided radiation therapy (SGRT) for accurate positioning and intrafraction monitoring.

SF-RT enabled expedited treatment in both cases while reducing procedural burden. Two GA interventions were eliminated with the use of SF-RT.

SF-RT shows promise in reducing GA requirements in paediatric palliative radiotherapy, offering benefits for patient experience and healthcare resource utilisation. These cases support the feasibility of SF-RT in select paediatric patients and highlight the need for broader implementation and further investigation in this population.