Streamlining Paediatric Palliative Radiotherapy: A Case Study on Reducing Procedural Burden and Avoiding General Anaesthesia Using a Simulation-Free Radiotherapy (SF-RT) Protocol.

Abstract

Background: Simulation-free radiotherapy (SF-RT) is a radiotherapy workflow which is growing in use in palliative treatment, allowing for planning on existing diagnostic CT (dCT) scans without the need for a dedicated planning CT (pCT). While this approach is being increasingly adopted in the adult population, its application in paediatric settings has been limited thus far.

Case presentation: We describe the first published report of two paediatric patients treated with SF-RT in a palliative context. Both children had advanced malignancies and were referred for single-fraction radiotherapy for symptom management. In the first case, a 5-year-old child underwent radiotherapy under general anaesthesia (GA) using SF-RT, eliminating the need for an additional GA for CT-Simulation (CT-Sim). In the second case, a 6-year-old child received treatment without GA, supported by other non-anaesthetic pharmacological interventions and surface guided radiation therapy (SGRT) for accurate positioning and intrafraction monitoring.

Results: SF-RT enabled expedited treatment in both cases while reducing procedural burden. Two GA interventions were eliminated with the use of SF-RT.

Conclusion: SF-RT shows promise in reducing GA requirements in paediatric palliative radiotherapy, offering benefits for patient experience and healthcare resource utilisation. These cases support the feasibility of SF-RT in select paediatric patients and highlight the need for broader implementation and further investigation in this population.