ESTRO 2024 - Abstract Book

S2023

Clinical - Paediatric

ESTRO 2024

Aurore Lecoeur, Magali Micaud, Jacques Balosso, Jordan Bouter, Charlotte Demoor-Goldschmidt, Fernand Missohou, Marc-André Mahé, Jean-Louis Habrand, Jeanne Riverain, Audrey Larnaudie

Centre François Baclesse, Radiotherapy, Caen, France

Purpose/Objective:

Immobilization during a protontherapy or radiotherapy session is necessary in order to treat accurately and safely. For children, this can be difficult to obtain at certain ages. General anaesthesia (GA) is one of the most used solutions in radiotherapy/protontherapy centres but it is prone to side effects and involves logistical challenge, particularly if treatment lasts several weeks. A distractive method was developed and implemented at the Centre François Baclesse in Caen, France, making it possible to avoid the use of general anaesthesia in young children [1]. This work summarizes our 10 year-experience, the benefits and the difficulties encountered.

Material/Methods:

The distractive method allows the child's attention to be diverted to something else during contention preparation, imaging - dosimetric scanner or others - and then treatment sessions. The young patient's medical track has therefore been adapted. For this, different meetings specifically dedicated are organized, with more information time comparatively to other treatment. The parents are implicated with radiation caregivers and participate to the distraction with the aim of making them actors in their child's treatment. Areas of interest of the children are deeply questioned in order to adapt the modalities. The young patient's treatment planning is optimized with sharing time and games between caregivers and families. Methods use fun accessories, sound and visual interactions during care, depending on the age of the patient.

Results:

Since 2012, all paediatric (photon) radiotherapies have been carried out without general anaesthesia in our department thanks to this distractive method. From 2018 protontherapy began in Caen in Normandy, France with 87 children treated without general anaesthesia. The youngest patients were 18 months. The duration of the sessions was 40 minutes on average, including the small game rituals inside the treatment room. Some sessions required the use of some medical premedication if occasional resistance to distraction. This situation can be met usually during the first three irradiation sessions. The major predictive factor of resistance was the fatigue in case of concomitant chemotherapy. Four patients had to be referred to other centres for treatment under GA. Decision was made if the first meetings did not allow the application of the distractive method to be considered reliably.

Conclusion:

The distractive method as carried out at the François Baclesse Centre and at the Caen protontherapy centre seems effective and safe for paediatric treatments.It permitted to deliver radiation treatment without general anaesthesia in the huge majority of the cases encountered, including for very young children. Means of adapted immobilizing devices to children are also a major asset in these treatments to ensure well-accepted and optimal repositioning. Dedicated time is essential for staff training, for information transmitted to families and for discussions prior to treatment. A longer session time should be taken into account compared to sessions with adult patients. However, compared to a session under general anaesthesia, the additional time is less. Major benefits are on the child's quality of life and the added value on the family - healthcare team relationship.