ESTRO 2025 - Abstract Book

S1616

Clinical – äediatric tumours

ESTRO 2025

591

Digital Poster The impact of iterative anesthesia on the outcomes of children undergoing proton radiotherapy Pascal Owusu-Agyemang 1 , Julie Mani 1 , Techecia Idowu 1 , Acsa Zavala 1 , january Tsai 1 , Jose Galdamez Melara 2 , Pallavi Muraleedharan 2 , Clara Francis 3 , Olakunle Idowu 1 , Juan P Cata 1 1 Anesthesiology, MD Anderson Cancer Center, Houston, USA. 2 Student, UT Helath, Houston, USA. 3 Student, Sam Houston State UniversityUT Helath, Huntsville, USA Purpose/Objective: Children undergoing proton beam therapy (PBT) require up to 30 treatments under general anesthesia over a period of 6 to 8 weeks, with each of these treatments lasting up to 60 minutes.1 To date, the impact of this many anesthetic exposures on the immediate and long-term outcomes of children undergoing PBT remains unclear. The primary objective of this study was to assess the association between iterative anesthesia exposure and the occurrence of an unplanned admission or emergency room encounter within 30 days of the start of treatment (UA). The secondary objective was to assess the impact of IA on patient survival. Material/Methods: Retrospective study of children (≤ 19 yrs.) who had undergone PBT (with or without anesthesia). Multivariable logistic regression was used to assess factors associated with an UA and survival. Results: The mean age of the 812 children included was 9 yrs. (SD: ± 5), 479/812 (56%) were male, and 308/812 (39%) required anesthesia. Overall, 42/812 (5%) children required an UA with fever being the most common reason 14/812 (2%). Compared to children who did not require anesthesia, the group who required anesthesia were younger (mean age, 4 yrs. [SD:±3] vs. 12 yrs. [SD: 4], p<0.001), had a higher proportion of children with previous chemotherapy (123/308 [40%] vs. 51/504 [10%], p<0.001), a higher proportion of those who had undergone complex PBT (127/308 [41%] vs. 136/504 [27%], p<0.001), and a higher incidence of UA (37/308 [12%] vs. 5/504 [1%], p<0.001). In the multivariable analysis, anesthesia and concurrent chemotherapy (CC) were each associated with increased odds of occurrence of an UA (OR, 14.13: 95%CI [14.13-36.54], p<0.001 for anesthesia), and (OR, 2.87: 95%CI [1.45 5.66], p=0.002 for CC). undergoing treatment under anesthesia was not associated with overall survival (OS) (no anesthesia versus anesthesia: HR, 1.49: 95%CI [0.89-2.51], p=0.129). In the subgroup of children with brain tumors (n=327), those who required anesthesia had a higher rate of UA (19/153 [12%] versus 0/174 [0%], p<0.001). However, OS rates (anesthesia vs. no-anesthesia) at 1 (87% vs. 88%), 2 (79% vs. 78%), and 3 (79% vs. 75%) years were similar between patient groups (p=0.869). Conclusion: In this retrospective study of children who had undergone PBT, undergoing treatment under anesthesia was associated with an unplanned admission or emergency room visit within 30 days of treatment start. However, there was no association between anesthesia exposure and patient survival.

Keywords: Iterative, Anesthesia, Outcomes

References: 1. Non-invasive anesthesia for children undergoing proton radiation therapy. Radiother Oncol. 2014 Apr;111(1):30 4. PMID: 24560754.