3129 - Assessment of Pattern of Requirement of General Anesthesia for Pediatric Patients Undergoing Radiotherapy

A. Aashita, A. Dagar, A. Vivekanandan, A. Ghosh, Y. I. K N, S. Hazarika, K. Kamboj, P. A. Patil, S. Vij, A. Sharma, D. N. Sharma, and S. Mallick; National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India

Purpose/Objective(s): Delivering radiotherapy for pediatric patients is a challenge and may require anesthesia for immobilization during radiotherapy. However, anesthesia may itself result in complications in addition to primary treatment associated toxicities. We sought to evaluate trend of anesthesia requirement, compliance and complications in pediatric cancer patients who received radiation under anesthesia. Materials/

Methods: Children who were treated with radiotherapy and required anesthesia from January 2021 to December 2023 were reviewed. Data of 60 patients and their treatment details was reviewed and analyzed.
Results: Mean age of the cohort was 4.26 years (range: 9 months to 11 years). The most common diagnosis was intracranial tumors (55.0%), retinoblastoma (16.67%) followed by soft tissue sarcoma and Wilm’s tumor (13.3% each). All patients got pre-anesthesia clearance.

One child developed bradycardia during induction and couldn’t be simulated for treatment. Remaining 59 patients were planned for radiotherapy (range: 1-33 fractions) depending on disease status. Of them, 31 children (51.6%) required anesthesia for all fractions of radiation. 19 children (31.6%) started their radiotherapy under anesthesia however, after initial fractions they were comfortable with treatment process and could receive remaining fractions without anesthesia. Two patients defaulted during treatment and for two patients treatment had to be stopped due to respiratory failure and severe acute malnutrition, respectively. 5 children (8.3%) were able to complete their treatment without anesthesia.

Complications were observed in 28 children (46.6%) - including desaturation (10), apnea (2), bradycardia (1), difficult extubation (1) and hematological toxicities (14). 8 children (13.3%) required gaps in their treatment with an average of 7 days (range: 2-19 days). 55 children (91.6%) were able to tolerate all the planned radiation fractions and complete their treatment.
Conclusion: Radiotherapy for children requires a specialized workforce including radiation oncologists, technicians, play specialists to familiarize the child and parents with understanding of the treatment process. Young children may require anesthesia during radiotherapy for adequate immobilization.

Strategies for making children comfortable in treatment area need to be implemented that may include special superhero and cartoon masks, toys in treatment room, doodles on wall of treatment area, audio and video distractions, gifts after radiation delivery and less waiting time should be worked up on in every center which can lead to less requirement of anesthesia and decrease in associated complications.