Indications et résultats de la protonthérapie dans le traitement des cancers

Doyen, J.; Bondiau, Pierre‐Yves; Bénézery, Karen; Thariat, Juliette; Vidal, M.; Gérard, A.; Hérault, J.; Carrié, C.; Hannoun-Lévi, J.-M.

doi:10.1016/j.canrad.2016.06.005

Cited by 10 publications

(3 citation statements)

References 55 publications

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“…4 Despite its high associated costs, PT also appears to be cost effective, as fewer side effects mean savings in overall cost. 5 PT in children often requires deep sedation or general anesthesia. This is due to a number of factors: the duration of PT sessions (which may last up to 90 min), their repetition (up to thirty times), the need for immobility, and the use of cribs and tight-fitting thermoplastic masks that can induce claustrophobia.…”

Section: Introductionmentioning

confidence: 99%

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Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

García‐Aroca,

Fernández‐de Miguel,

Franceschi

et al. 2023

Pediatric Anesthesia

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IntroductionProton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols.MethodsWe reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway.ResultsOf the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non‐serious adverse effects was 0.7% (Clopper–Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper–Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches.ConclusionInhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.

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Section: Introductionmentioning

confidence: 99%

“…Despite initial doubts about its long‐term effectiveness and associated harms, 3 recent assessments shows that PT is indicated for children and adults with certain types of cancer 4 . Despite its high associated costs, PT also appears to be cost effective, as fewer side effects mean savings in overall cost 5 …”

Section: Introductionmentioning

confidence: 99%

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

García‐Aroca,

Fernández‐de Miguel,

Franceschi

et al. 2023

Pediatric Anesthesia

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“…In contrast with photons, protons have the advantage to stop at a given depth (where the tumor is located), with reduced straggling and resulting in a significant reduction of integral dose to surrounding tissues. Proton therapy (PT) is considered as an alternative to conventional RT, especially in pediatric patients [8]. Nowadays, protons are frequently used instead of photons due to their ballistic properties which allow to treat tumors localized near organs at risk (OAR) without leading to toxicities in these OAR [9].…”

Section: Introductionmentioning

confidence: 99%

Biological Effects of Scattered Versus Scanned Proton Beams on Normal Tissues in Total Body Irradiated Mice: Survival, Genotoxicity, Oxidative Stress and Inflammation

et al. 2020

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Side effects of proton therapy are poorly studied. Moreover, the differences in the method of dose delivery on normal tissues are not taken into account when proton beams are scanned instead of being scattered. We proposed here to study the effects of both modalities of proton beam delivery on blood; skin; lung and heart in a murine model. In that purpose; C57BL/6 mice were total body irradiated by 190.6 MeV proton beams either by Double Scattering (DS) or by Pencil Beam Scanning (PBS) in the plateau phase before the Bragg Peak. Mouse survival was evaluated. Blood and organs were removed three months after irradiation. Biomarkers of genotoxicity; oxidative stress and inflammation were measured. Proton irradiation was shown to increase lymphocyte micronucleus frequency; lung superoxide dismutase activity; erythrocyte and skin glutathione peroxidase activity; erythrocyte catalase activity; lung; heart and skin oxidized glutathione level; erythrocyte and lung lipid peroxidation and erythrocyte protein carbonylation even 3 months post-irradiation. When comparing both methods of proton beam delivery; mouse survival was not different. However, PBS significantly increased lymphocyte micronucleus frequency; erythrocyte glutathione peroxidase activity and heart oxidized glutathione level compared to DS. These results point out the necessity to take into account the way of delivering dose in PT as it could influence late side effects.

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Nécessité d’une réflexion globale autour des thérapeutiques « personnalisées » proposées en oncologie pédiatrique

Chastagner

2017

Archives de Pédiatrie

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Indications et résultats de la protonthérapie dans le traitement des cancers

Cited by 10 publications

References 55 publications

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

Biological Effects of Scattered Versus Scanned Proton Beams on Normal Tissues in Total Body Irradiated Mice: Survival, Genotoxicity, Oxidative Stress and Inflammation

Nécessité d’une réflexion globale autour des thérapeutiques « personnalisées » proposées en oncologie pédiatrique

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