Non-invasive anesthesia for children undergoing proton radiation therapy

Owusu-Agyemang, Pascal; Grosshans, David R.; Arunkumar, Radha; Rebello, Elizabeth; Popovich, Shannon; Zavala, Acsa M.; Williams, Cynthia; Ruíz, Jordi; Hernandez, Mike; Mahajan, Anita; Porche, Vivian H.

doi:10.1016/j.radonc.2014.01.016

Cited by 37 publications

(22 citation statements)

References 18 publications

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“…In the present study, there is a clear difference in the average age between the two groups, and there is a tendency similar to previous reports. Currently, there is a consensus on general anesthesia for children under 3 years of age during radiation therapy 12 . However, for children aged 7-8 years, the criteria for general anesthesia between institutions are ambiguous and there is no consensus.…”

Section: Discussionmentioning

confidence: 99%

“…As for patients treated in our hospital, it was found that propofol alone could be used to reduce physical activity without the need for LMA management in one case. In a previous report, Owusu-Agyemang et al 12 performed a total of 9,430 proton treatments in 340 patients and performed intravenous anesthesia (sedation) only with propofol in all patients. As a result, although LMA was inserted in 2 cases due to a decrease in oxygen saturation, it was reported that 97.3% of cases could be managed without securing the airway.…”

Section: Discussionmentioning

confidence: 99%

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Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Shimazu

Otsuki

Murakami

et al. 2020

Sci Rep

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Proton therapy for paediatric cancer patients is an effective treatment; however, young children have may have difficulties staying still during irradiation. This study investigated the indication of general anaesthesia in paediatric proton therapy. Background information and anaesthesia/treatment protocols were retrospectively extracted from the medical records of cancer patients under 15 years who underwent proton therapy at Southern TOHOKU General Hospital, Fukushima, Japan between April 2016 and December 2018. The anaesthesia and non-anaesthesia groups were compared to evaluate factors determining the need for general anaesthesia. Thirty-two patients who received 285 irradiations were analysed. The median age was 5 years old (range: 1–15), and 13 patients (40.6%) were female. Twelve (37.5%) patients received general anaesthesia. In the general anaesthesia group, airway management using a laryngeal mask was performed in 11 patients (91.6%). Patient age was significantly lower in the general anaesthesia group than in the non-anaesthetised group (p < 0.001). Considering all background factors, only age was strongly associated with anaesthesia in the univariate logistic regression model (odds ratio 0.55 [95% confidence interval 0.35–0.86]; P < 0.01). Thus, age is one of the most important factors determining the need for general anaesthesia during proton therapy in children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Shimazu

Otsuki

Murakami

et al. 2020

Sci Rep

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“…Bone marrow suppression and recovery is being actively evaluated at our institution. Owusu-Agyemang [27] reviewed the anesthesia experience at our institution of 340 patients treated between 2006 and 2013. One hundred thirty (40%) patients were treated with p-CSI and anesthesia for all or part of the course of treatment.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Proton Craniospinal Radiation Therapy: Rationale and Clinical Evidence

Mahajan¹

2014

International Journal of Particle Therapy

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Purpose: To review the existing evidence that supports the use of proton craniospinal irradiation (p-CSI) in pediatric patients. Materials and Methods: A literature review was performed exploring the current evidence for the use of p-CSI. The theoretical advantages based on dosimetry and predictive toxicity models are described. The technical advances in p-CSI delivery are reviewed. The existing and emerging clinical data, including cost-benefit analyses are evaluated. Results: The theoretical advantages based on dosimetry comparisons to x-ray-based CSI consistently support the potential benefit of p-CSI. Similarly, the predictive models suggest a reduction in the risks of organ toxicity and radiation-associated second malignancies. The early clinical data that are emerging confirm similar tumor control rates with some support of reduction in early measurable toxicities. Several studies support an overall cost-benefit advantage when the potential reduction in side effects with p-CSI is considered. Conclusions: Based on the theoretical and early clinical outcomes, p-CSI appears to provide equal tumor control with potentially reduced risk of side effects when compared with data. Ongoing efforts will continue to evaluate these advantages.

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“…Craniospinal irradiation requires careful evaluation of patient setup at simulation and daily treatments. 49 Computed tomography planning is essential for proton therapy. 47 Many aspects of photon-based CSI are directly applicable to CSI delivered using proton therapy.…”

Section: Csi Techniquementioning

confidence: 99%

Embryonal Brain Tumors

2014

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Embryonal brain tumors are a heterogeneous group of neoplasms that primarily occur in infants and young children. They are highly cellular tumors with brisk mitotic activity, and they share a propensity for dissemination throughout the neuroaxis. Emerging molecular data enable improved diagnostic and prognostic discrimination for these tumors. Because of their aggressive potential, they are treated similarly with multimodality therapy including maximal safe resection, chemotherapy, and age- and risk-adapted radiotherapy. Craniospinal irradiation is commonly used in the treatment of these patients, especially in those older than 3 years. Because proton therapy allows for increased sparing of the anterior structures in craniospinal irradiation, there is a particular interest in using proton therapy to treat these young patients. For very young patients treated with focal fields only, proton therapy also decreases unnecessary radiation exposure to uninvolved intracranial structures. It is hoped that the use of proton therapy for these vulnerable patients will translate into decreased long-term neurocognitive, endocrine, vascular, and developmental effects, in addition to a decreased risk of second malignancies. This review describes the role of radiation in general and proton therapy in particular for the treatment of medulloblastoma, central nervous system primitive neuroectodermal tumors, atypical teratoid/rhabdoid tumors, and the recently described embryonal tumor with multilayered rosettes.

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Non-invasive anesthesia for children undergoing proton radiation therapy

Cited by 37 publications

References 18 publications

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

Proton Craniospinal Radiation Therapy: Rationale and Clinical Evidence

Embryonal Brain Tumors

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