LaRiviere Michael J, Shah Yash B, Cummings Elizabeth R, Clegg Kelly, Doucette Abigail, Struyk Brian P, Lustig Robert A, Kurtz Goldie, Hill-Kayser Christine E
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2022 Jul-Aug;7(4):100929. doi: 10.1016/j.adro.2022.100929. Epub 2022 Mar 6.
Managing pediatric patients requiring daily general anesthesia (GA) for radiation therapy (RT) in the setting of COVID-19 is complex, owing to the aerosolizing nature of GA procedures, the risk of cardiopulmonary complications for infected patients, and the treatment of immunocompromised oncology patients in a busy, densely populated radiation oncology clinic.
We developed an institutional protocol to define procedures for COVID-19 testing and protection of patients, caregivers, and staff, hypothesizing that this protocol would allow patients requiring GA to be safely treated, minimizing COVID-19 transmission risk to both patients and staff, and at the same time maintaining pre-COVID-19 patient volumes. All patients underwent COVID-19 testing before their first treatment and thrice weekly during treatment. For patients who tested positive for COVID-19, RT was delivered in the last end-of-day treatment appointment. A negative pressure room was used for GA induction and recovery, and separate physician/nurse teams were designated for in-room versus out-of-room patient management.
Seventy-eight pediatric patients received RT under GA, versus 69 over the same prior year timeframe, and 2 patients received 2 courses of RT under GA, for a total of 80 courses. The mean age was 4.9 years (range, 0.5-19.0 years) and 41 of 78 (52.6%) were male. Two patients (2.6%) received 2 courses of RT under GA, establishing a total of 80 courses. The mean number of treatment fractions was 22.2 (range, 1-40). Two of 78 patients (2.6%) tested positive for COVID-19; both were asymptomatic. Both patients completed treatment as prescribed. Neither patient developed cardiopulmonary symptoms complicating anesthesia, and neither patient experienced grade 3+ acute radiation toxicity.
With careful multidisciplinary planning to mitigate COVID-19 risk, pediatric RT with GA was carried out for a large patient volume without widespread infection and without increased toxic effects from either GA or RT.
在2019冠状病毒病（COVID-19）背景下，管理因放射治疗（RT）而需要每日接受全身麻醉（GA）的儿科患者是一项复杂的工作，这是由于全身麻醉操作具有产生气溶胶的特性、感染患者出现心肺并发症的风险，以及在繁忙且人员密集的放射肿瘤诊所中对免疫功能低下的肿瘤患者进行治疗。
我们制定了一项机构方案，以确定COVID-19检测以及保护患者、护理人员和工作人员的程序，推测该方案将使需要全身麻醉的患者得到安全治疗，将COVID-19传播风险降至最低，同时保持COVID-19疫情前的患者数量。所有患者在首次治疗前接受COVID-19检测，并在治疗期间每周进行三次检测。对于COVID-19检测呈阳性的患者，放射治疗在当天最后一次治疗预约时进行。负压室用于全身麻醉诱导和苏醒，并且指定了单独的医生/护士团队分别负责室内和室外患者管理。
78名儿科患者在全身麻醉下接受了放射治疗，而前一年同期为69名，2名患者在全身麻醉下接受了2个疗程的放射治疗，总共80个疗程。平均年龄为4.9岁（范围0.5 - 19.0岁），78名患者中有41名（52.6%）为男性。2名患者（2.6%）在全身麻醉下接受了2个疗程的放射治疗，共80个疗程。平均治疗分次数量为22.2次（范围1 - 40次）。78名患者中有2名（2.6%）COVID-19检测呈阳性；两人均无症状。两名患者均按规定完成治疗。两名患者均未出现使麻醉复杂化的心肺症状，也均未经历3级及以上急性放射毒性反应。
通过精心的多学科规划以降低COVID-19风险，大量儿科患者在全身麻醉下进行了放射治疗，没有出现广泛感染，全身麻醉或放射治疗也没有增加毒性作用。
