Owusu-Agyemang Pascal, Mani Julie, Idowu Techecia, Zavala Acsa, Tsai January, Kapoor Ravish, Idowu Olakunle, Galdamez Melara Jose, Muraleedharan Pallavi, Francis Clara, Feng Lei, Cata Juan
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Anesthesiology and Surgical Oncology Research Group, Houston, TX 77030, USA.
Cancers (Basel). 2025 Jun 7;17(12):1904. doi: 10.3390/cancers17121904.
Patient motion poses significant challenges for the accurate delivery of radiotherapy. In children undergoing proton beam therapy (PBT), up to 30 treatments under general anesthesia may be required over a period of 6 to 8 weeks. To date, the impact of this many iterative anesthetic exposures on patient outcomes remains unclear. The primary objective of this study was to assess the impact of iterative anesthesia with propofol-based total intravenous anesthesia (propofol-TIVA) on overall survival. The secondary objective was to assess the association between propofol-TIVA and the occurrence of an unplanned admission or emergency room visit within 30 days of treatment start. This was a retrospective study of children (≤19 years) who had undergone PBT (with or without anesthesia) for central nervous system disease. The Log-rank test and Cox proportional hazards models were used for analysis. Propensity score matching and E-value analyses were used to adjust for selection bias. The average age of the 461 children included was 9.0 years (SD ± 4.9). The majority, 261/461 (56.6%), were male, and 267/461 (57.9%) had undergone PBT without anesthesia. The group who underwent PBT with propofol-TIVA were younger (4.7 years vs. 12.2 years, < 0.001) and had higher proportions of patients with treatment interruptions (111/194 [57.2%] vs. 118/267 [44.2%], = 0.006), chemotherapy history (64/194 [33.0%] vs. 18/267 [6.7%], < 0.001), concurrent chemotherapy (37/194 [19.1%] vs. 27/267 [10.1%], = 0.006), and unplanned admissions/emergency room visits (26/194 [13.4%] vs. 1/267 [0.4%], < 0.001). Overall survival rates (propofol-TIVA vs. no anesthesia) at 1yr (94% vs. 96%), 2 years (88% vs. 90%), and 3 years (88% vs. 89%) were similar between patient groups ( = 0.558). In the multivariable analysis, PBT with propofol-TIVA was associated with increased odds of an unplanned admission/emergency room visit before (OR, 38.311; 95%CI, 5.139-285.580; < 0.001) and after (OR, 42.012; 95% CI, 5.322-331.632; < 0.001; E-value = 83.52) propensity score matching. In this retrospective study of children undergoing PBT for central nervous system disease, there was no association between anesthesia exposure with propofol-based total intravenous anesthesia and overall survival. However, PBT with propofol-based total intravenous anesthesia was associated with an increased risk of an unplanned admission/emergency room visit within 30 days of treatment start.
患者的身体移动对精确放疗构成了重大挑战。在接受质子束治疗（PBT）的儿童中，在6至8周的时间内可能需要进行多达30次全身麻醉下的治疗。迄今为止，如此多次反复的麻醉暴露对患者预后的影响仍不明确。本研究的主要目的是评估基于丙泊酚的全静脉麻醉（丙泊酚-TIVA）反复麻醉对总生存期的影响。次要目的是评估丙泊酚-TIVA与治疗开始后30天内非计划住院或急诊就诊发生率之间的关联。这是一项对因中枢神经系统疾病接受PBT（无论是否麻醉）的儿童（≤19岁）进行的回顾性研究。采用对数秩检验和Cox比例风险模型进行分析。倾向得分匹配和E值分析用于调整选择偏倚。纳入的461名儿童的平均年龄为9.0岁（标准差±4.9）。大多数，即261/461（56.6%）为男性，267/461（57.9%）接受了未麻醉的PBT。接受丙泊酚-TIVA进行PBT的组年龄更小（4.7岁对12.2岁，<0.001），治疗中断的患者比例更高（111/194[57.2%]对118/267[44.2%]，=0.006），有化疗史的比例更高（64/194[33.0%]对18/267[6.7%]，<0.001），同时进行化疗的比例更高（37/194[19.1%]对27/267[10.1%]，=0.006），以及非计划住院/急诊就诊的比例更高（26/194[13.4%]对1/267[0.4%]，<0.001）。患者组之间1年（94%对96%）、2年（88%对90%）和3年（88%对89%）的总生存率相似（=0.558）。在多变量分析中，丙泊酚-TIVA进行PBT与倾向得分匹配前（比值比，38.311；95%置信区间，5.139-285.580；<0.001）和匹配后（比值比，42.012；95%置信区间，5.322-331.632；<0.001；E值=83.52）非计划住院/急诊就诊的几率增加相关。在这项对因中枢神经系统疾病接受PBT的儿童进行的回顾性研究中，基于丙泊酚的全静脉麻醉暴露与总生存期之间没有关联。然而，基于丙泊酚的全静脉麻醉进行PBT与治疗开始后30天内非计划住院/急诊就诊的风险增加相关。
