Pediatric radiation therapy: Novel anesthesia approaches for a smoother experience

Received: 27-Jul-2023, Manuscript No. OAR-23-108253; Accepted: 23-Aug-2023, Pre QC No. OAR-23-108253(PQ); Editor assigned: 31-Jul-2023, Pre QC No. OAR-23-108253(PQ); Reviewed: 08-Aug-2023, QC No. OAR-23-108253(Q); Revised: 21-Aug-2023, Manuscript No. OAR-23-108253(R); Published: 29-Aug-2023, DOI: -

Introduction

Radiotherapy, also known as radiation therapy, is a medical treatment modality used in the management of cancer and other conditions. It involves the targeted delivery of high-energy radiation to specific areas of the body affected by malignant cells or tumors [1]. The radiation damages the DNA of the cancer cells, inhibiting their ability to divide and grow, thus leading to their destruction or control. Radiotherapy can be administered externally, where radiation is directed at the body from an external machine, or internally, through the placement of radioactive sources directly into or near the tumor [2]. The goal of radiotherapy is to eliminate or shrink tumors, relieve symptoms, and improve patient outcomes [3].

Pediatric radiation therapy plays a critical role in the treatment of children with cancer, providing targeted and localized radiation to eliminate or control malignant cells. While effective in its primary goal of eradicating cancer cells, radiation therapy can be a daunting and challenging experience for pediatric patients. The need for immobilization, the unfamiliar treatment environment, and the potential for discomfort or pain during the procedure contribute to significant anxiety and distress [4-6]. To mitigate these challenges and optimize patient outcomes, novel anesthesia approaches have been developed and implemented specifically for pediatric radiation therapy. Traditionally, anesthesia has been utilized in pediatric settings to manage pain, anxiety, and facilitate patient compliance during various medical procedures. However, the unique nature of radiation therapy calls for tailored anesthesia approaches that consider both the specific demands of radiation treatment and the individual needs of pediatric patients [7-9]. The goal is to ensure a smoother treatment experience, minimize anxiety, and enhance patient cooperation, thus improving treatment efficacy.

This review article aims to explore and discuss the novel anesthesia approaches that have been developed and implemented in pediatric radiation therapy. By examining the existing literature, advancements, and clinical experiences, we aim to provide insights into the efficacy, safety, and benefits of these innovative techniques. Child-centered anesthesia approaches form a crucial component of the novel techniques employed in pediatric radiation therapy. Recognizing the importance of a child's psychological well-being and comfort, these approaches focus on creating a supportive and interactive environment that includes play therapy, distraction techniques, and parental involvement.

By engaging the child's imagination, providing a sense of control, and reducing treatment-associated fear, child-centered anesthesia approaches contribute to a more positive treatment experience, increased compliance, and improved outcomes. Moreover, technological advancements in radiation therapy, such as ImageGuided Radiation Therapy (IGRT) and respiratory gating, have allowed for more precise delivery of radiation and motion management [10,11]. These developments have opened avenues for anesthesia techniques that minimize sedation requirements, thus reducing potential risks and side effects associated with deep sedation or general anesthesia.

Challenges to anesthesiologist for pediatric radiotherapy

Anesthesiologists face several challenges when implementing novel anesthesia approaches for pediatric radiation therapy [12,13]. These challenges arise from the specific nature of radiation therapy, the unique needs of pediatric patients, and the goal of providing a smooth and comfortable treatment experience. Understanding and addressing these challenges are crucial to ensuring successful anesthesia management and optimizing patient outcomes. One of the primary challenges for anesthesiologists in pediatric radiation therapy is the need for precise and individualized treatment planning. Each radiation session requires accurate positioning and immobilization of the child to ensure the targeted delivery of radiation to the affected area while minimizing exposure to healthy tissues [14]. Anesthesiologists must work closely with radiation oncologists to develop anesthesia strategies that allow for effective immobilization while maintaining patient comfort and cooperation. Another challenge is managing the anxiety and fear experienced by pediatric patients undergoing radiation therapy. Children may have limited understanding of the treatment process and its potential benefits, which can lead to heightened anxiety and resistance [15]. Anesthesiologists play a vital role in addressing these emotional challenges by employing child-friendly approaches such as play therapy, age-appropriate explanations, and the involvement of parents or caregivers. By creating a supportive and reassuring environment, anesthesiologists can help alleviate anxiety and enhance patient cooperation.

Additionally, anesthesiologists must consider the potential side effects and long-term consequences of anesthesia in pediatric patients. While the goal is to minimize discomfort and anxiety, anesthesiologists must carefully evaluate the risks and benefits of anesthesia techniques, especially when considering the potential impact on cognitive development and neurocognitive functioning. Balancing the need for sedation or anesthesia with the potential risks requires a comprehensive assessment of each patient's medical history, current health status, and anticipated treatment duration. Furthermore, interdisciplinary collaboration poses a challenge for anesthesiologists in pediatric radiation therapy. Effective communication and teamwork among anesthesiologists, radiation oncologists, pediatric oncologists, psychologists, and radiation therapists are essential for ensuring cohesive and coordinated care. Regular meetings, joint treatment planning sessions, and shared decision-making processes facilitate a multidisciplinary approach that takes into account the unique needs of each patient [16,17].

The future of anesthesia for radiation therapy among pediatric age group

Non-pharmacological interventions offer a promising avenue for the future of sedation and anesthesia in the radiation oncology suite for pediatric patients. Techniques such as virtual reality, music therapy, and mindfulness-based approaches have shown success in reducing anxiety and promoting relaxation in other medical settings. Integrating these interventions into the radiation oncology suite could provide additional options for managing distress and improving the overall patient experience [18]. Precision medicine holds great potential for the future of sedation and anesthesia in pediatric radiation therapy. Advancements in genetic profiling and personalized medicine may allow for tailored approaches based on an individual child's genetic makeup and specific responses to medications. This personalized approach could optimize anesthesia management by considering factors such as drug metabolism and sensitivity, resulting in improved safety, efficacy, and patient outcomes [19]. Technology advancements, such as improved monitoring systems and imaging techniques, may also shape the future of sedation and anesthesia in the radiation oncology suite. The development of more precise and non-invasive monitoring devices can enhance patient safety and facilitate real-time adjustments in anesthesia management. Additionally, advanced imaging techniques, such as functional MRI or PET-CT, could aid in identifying brain activity and responses to anesthesia, enabling more targeted and individualized sedation approaches [20-22].

Further research and innovation in pharmacological agents used for sedation and anesthesia are likely to play a role in the future. The development of new medications with improved safety profiles, faster onset, and shorter durations of action could enhance the efficiency and recovery time for pediatric patients undergoing radiation therapy. Additionally, the exploration of alternative routes of medication administration, such as transdermal or intranasal delivery, may offer non-invasive and convenient options for sedation and anesthesia [23].

The role of simulation in anesthesia for radiation therapy among pediatric age group

Simulation in anesthesia for radiation therapy among the pediatric age group is an emerging and valuable tool that offers numerous benefits for both patients and healthcare providers. Simulation involves creating realistic scenarios or environments to mimic clinical situations, allowing practitioners to practice and refine their skills in a safe and controlled setting. In the context of anesthesia for pediatric radiation therapy, simulation provides a unique opportunity to train anesthesiologists, radiation oncologists, and the interdisciplinary team involved in delivering care to young patients [24].

One of the primary advantages of simulation is the ability to recreate realistic scenarios that closely resemble the radiation therapy procedure for pediatric patients. This allows healthcare providers to become familiar with the equipment, protocols, and challenges specific to pediatric radiation therapy, such as positioning, immobilization devices, and monitoring requirements. By practicing in a simulated environment, healthcare providers can enhance their knowledge and technical skills, ensuring the delivery of safe and effective anesthesia during the actual procedure [25].

Simulation also facilitates the development of communication and teamwork skills among the healthcare team. Collaboration and coordination are crucial in the radiation oncology suite, where multiple healthcare professionals, including anesthesiologists, radiation oncologists, nurses, and radiation therapists, work together to provide optimal care. Simulation scenarios enable interdisciplinary team members to practice their roles, responsibilities, and effective communication strategies, leading to improved coordination, decision-making, and patient safety during the radiation therapy process [26].

Moreover, simulation provides an opportunity to address potential challenges and complications that may arise during pediatric radiation therapy. Healthcare providers can simulate adverse events, emergency situations, or rare scenarios, allowing them to develop critical thinking skills, practice rapid decision-making, and refine their response to emergencies. This proactive approach helps enhance preparedness, reduces errors, and improves patient outcomes [27].

Simulation-based education and training in anesthesia for pediatric radiation therapy also offer the advantage of providing a standardized and consistent learning experience for healthcare providers. Participants can repeat scenarios, receive immediate feedback, and engage in debriefing sessions to reflect on their performance and identify areas for improvement. This iterative process fosters a culture of continuous learning and quality improvement, ultimately benefiting the care provided to pediatric patients undergoing radiation therapy [28].

The role of simulation in anesthesia for radiation therapy among pediatric age group

Artificial Intelligence (AI) holds significant promise in revolutionizing radiation therapy for pediatric patients. AI algorithms can analyze large volumes of patient data, such as medical images, treatment histories, and outcomes, to aid radiation oncologists in creating personalized treatment plans [29]. By incorporating patient-specific characteristics and tumor biology, AI can optimize treatment parameters to achieve the best possible outcomes while reducing the risk of radiation-related side effects in pediatric patients [30-32]. This personalized approach ensures that each child receives the most effective and safe radiation therapy tailored to their unique needs. Additionally, AI can play a crucial role in automating and expediting the treatment planning process. Traditional treatment planning can be time consuming, but with AI-driven automation, it becomes more efficient, allowing clinicians to focus more on patient care. AI can quickly analyze medical images and assist in contouring organs at risk and target volumes, streamlining the planning process and reducing the time between diagnosis and treatment initiation for pediatric patients [33]. In radiation therapy delivery, AI-powered image analysis and real-time monitoring offer further advantages. AI algorithms can assist in accurately verifying patient positioning and motion during treatment, ensuring precise radiation delivery to the targeted area and minimizing irradiation of healthy tissues. This level of accuracy is particularly crucial for pediatric patients, as they may be more sensitive to radiation's long-term effects [34]. AI can provide real-time feedback to radiation therapists, alerting them to any deviations from the treatment plan and allowing for immediate adjustments, thus enhancing treatment safety and efficacy. Another potential role of AI lies in predicting treatment responses and potential side effects for pediatric patients. By leveraging historical treatment data and patient outcomes, AI can provide valuable insights into how individual patients may respond to radiation therapy. This predictive capability enables clinicians to optimize treatment strategies and better inform families about potential risks and benefits [35].

Conclusion

Novel anesthesia approaches designed specifically for pediatric radiation therapy play a pivotal role in enhancing the treatment experience for young patients. Child-centered care, incorporating play therapy, distraction techniques, and parental involvement, reduces anxiety and fosters a positive environment. Technological advancements, like image-guided radiation therapy and respiratory gating, minimize sedation requirements, enhancing patient safety. Moreover, interdisciplinary collaboration among healthcare professionals ensures comprehensive and tailored care. These advancements not only alleviate patient discomfort but also improve treatment compliance and overall treatment outcomes. Moving forward, continued research and innovation in anesthesia techniques will further optimize the pediatric radiation therapy process, benefiting young patients and their families in their journey toward improved health and well-being. The incorporation of novel anesthesia approaches, simulation, and artificial intelligence (AI) in pediatric radiation therapy demonstrates a significant impact on the overall treatment experience.

References

1. Mehta SR, Suhag V, Semwal M, Sharma N. Radiotherapy: Basic Concepts and Recent Advances. Med J Armed Forces India. 2010;66:158-162. doi: 10.1016/S0377-1237:80132-80137

   [Google Scholar] [CrossRef]

2. Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and radiation therapy: current advances and future directions. Int J Med Sci. 2012;9:193-199.

   [Google Scholar] [CrossRef]

3. Gianfaldoni S, Gianfaldoni R, Wollina U, Lotti J, Tchernev G, Lotti T. An Overview on Radiotherapy: From Its History to Its Current Applications in Dermatology. Open Access Maced J Med Sci. 2017;5:521-525..

   [Google Scholar] [CrossRef]

4. O'Connor M, Halkett GK. A systematic review of interventions to reduce psychological distress in pediatric patients receiving radiation therapy. Patient Educ Couns. 2019;102:275-283[Google Scholar]

   [CrossRef]

5. Holt DE, Hiniker SM, Kalapurakal JA. Improving the Pediatric Patient Experience During Radiation Therapy-A Children's Oncology Group Study. Int J Radiat Oncol Biol Phys. 2021;109:505-514.

   [Google Scholar] [CrossRef]

6. Natale JL. Reducing Pediatric Patient Anxiety: Implementing a Nonpharmacologic Intervention to Aid Patients Undergoing Radiation Therapy. Clin J Oncol Nurs. 2021;25:215-218.

   [Google Scholar] [CrossRef]

7. Ntoukas SM, Ritchie T, Awrey S. Minimizing General Anesthetic Use in Pediatric Radiation Therapy. Pract Radiat Oncol. 2020;10:159-165.

   [Google Scholar] [CrossRef]

8. Owusu-Agyemang P, Tsai JY, Kapoor R. Survey of Anesthesia, Sedation, and Non-sedation Practices for Children Undergoing Repetitive Cranial or Craniospinal Radiotherapy. Cureus. 2022;14:24075.

   [Google Scholar] [CrossRef]

9. McFadyen JG, Pelly N, Orr RJ. Sedation and anesthesia for the pediatric patient undergoing radiation therapy. Curr Opin Anaesthesiol. 2011;24:433-438.

   [Google Scholar] [CrossRef]

10. Dawson LA, Jaffray DA. Advances in image-guided radiation therapy. J Clin Oncol. 2007;10:938-46.

    [Google Scholar] [CrossRef]

11. Nabavizadeh N, Elliott DA, Chen Y. Image Guided Radiation Therapy (IGRT) Practice Patterns and IGRT's Impact on Workflow and Treatment Planning: Results From a National Survey of American Society for Radiation Oncology Members. Int J Radiat Oncol Biol Phys. 2016;94:850-857.

    [Google Scholar] [CrossRef]

12. Anghelescu DL, Burgoyne LL, Liu W. Safe anesthesia for radiotherapy in pediatric oncology: St. Jude Children's Research Hospital Experience, 2004-2006. Int J Radiat Oncol Biol Phys. 2008;71:491-497. [Google Scholar]

    [CrossRef]

13. Verma V, Beethe AB, LeRiger M. Anesthesia complications of pediatric radiation therapy. Pract Radiat Oncol. 2016;6:143-154.

    [Google Scholar] [CrossRef]

14. Hertzog JH, Dalton HJ, Anderson BD. Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics. 2000;106:742-747.

    [Google Scholar] [CrossRef]

15. Cravero JP, Blike GT, Beach M. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics. 2006;118:1087-1096

    [Google Scholar] [CrossRef]

16. Scheiber G, Ribeiro FC, Karpienski H, Strehl K. Deep sedation with propofol in preschool children undergoing radiation therapy. Paediatr Anaesth. 1996;6:209-213.

    [Google Scholar] [CrossRef]

17. Garewal D, Powell S, Milan SJ, Nordmeyer J, Waikar P. Sedative techniques for endoscopic retrograde cholangiopancreatography. Cochrane Database Syst Rev. 2012;CD007274.

    [Google Scholar] [CrossRef]

18. Costi D, Cyna AM, Ahmed. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014;CD007084.

    [Google Scholar] [CrossRef]

19. Ortiz AC, Atallah AN, Matos D, da Silva EM. Intravenous versus inhalational anaesthesia for paediatric outpatient surgery. Cochrane Database Syst Rev. 2014;CD009015.

    [Google Scholar] [CrossRef]

20. Oh TK, Lee SJ, Kim JH, Park B, Eom W. The administration of high-dose propofol sedation with manual and target-controlled infusion in children undergoing radiation therapy: a 7-year clinical investigation. Springerplus. 2016;5:376.

    [Google Scholar] [CrossRef]

21. Buehrer S, Immoos S, Frei M, Timmermann B, Weiss M. Evaluation of propofol for repeated prolonged deep sedation in children undergoing proton radiation therapy. Br J Anaesth. 2007;99:556-560.

    [Google Scholar] [CrossRef]

22. Frei-Welte M, Weiss M, Neuhaus D, Ares C, Mauch J. Kinderanästhesie zur protonenbestrahlung : medizin fernab der klinik [Pediatric anesthesia for proton radiotherapy : medicine remote from the medical centre]. Anaesthesist. 2012;61:906-914.

    [Google Scholar] [CrossRef]

23. Ares C, Albertini F, Frei-Welte M. Pencil beam scanning proton therapy for pediatric intracranial ependymoma. J Neurooncol. 2016;128:137-145

    [Google Scholar] [CrossRef]

24. Rai E, Naik V, Singariya G, Bathla S, Sharma R, Pani N. Recent advances in paediatric anaesthesia. Indian J Anaesth. 2023;67:27-31.

    [Google Scholar] [CrossRef]

25. Ivani G, Suresh S, Ecoffey C. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia. Reg Anesth Pain Med. 2015;40:526-532.

    [Google Scholar] [CrossRef]

26. Suresh S, Ecoffey C, Bosenberg A. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Reg Anesth Pain Med. 2018;43:211-216.

    [Google Scholar] [CrossRef]

27. Basic Concepts and Recent Advances. Med J Armed Forces India
28. Jacola LM, Anghelescu DL, Hall L. Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma. J Pediatr. 2020;223:141-147. [Google Scholar] [CrossRef]
29. Johnson KB, Wei WQ, Weeraratne D, Frisse ME, Misulis K et al., Precision Medicine, AI, and the Future of Personalized Health Care. Clin Transl Sci. 2021;14:86-93

    [Google Scholar] [CrossRef]

30. Siddique S, Chow JCL. Artificial intelligence in radiotherapy. Rep Pract Oncol Radiother. 2020;25:656-66.

    [Google Scholar] [CrossRef]

31. Vobugari N, Raja V, Sethi U, Gandhi K, Raja K et al.. Advancements in Oncology with Artificial Intelligence—A Review Article. Cancers. 2022;14:1349 [Google Scholar]

    [CrossRef]

32. Slanetz PJ, Reede D, Ruchman RB. Strengthening the Radiology Learning Environment. J Am Coll Radiol. 2018;15:1016-1018.

    [Google Scholar] [CrossRef]

33. Daldrup-Link H. Artificial intelligence applications for pediatric oncology imaging. Pediatr Radiol. 2019;49:1384-1390.

    [Google Scholar] [CrossRef]

34. Beaton L, Bandula S, Gaze MN, Sharma RA. How rapid advances in imaging are defining the future of precision radiation oncology. British journal of cancer. 2019;120:779-90.

    [Google Scholar] [CrossRef]

35. Lightfoote JB, Fielding JR, Deville C, Gunderman RB, Morgan GN,et al., Improving diversity, inclusion, and representation in radiology and radiation oncology part 1: why these matter. J Am Coll Radiol. 2014;11:673-80

    [Google Scholar] [CrossRef]