Background: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.Objective: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.Methods: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.Results: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,p< 0.001) and had higher proportions of patients with treatment interruptions (111/194 [57.2%] vs. 118/267 [44.2%],p= 0.006), chemotherapy history (64/194 [33.0%] vs. 18/267 [6.7%],p< 0.001), concurrent chemotherapy (37/194 [19.1%] vs. 27/267 [10.1%],p= 0.006), and unplanned admissions/emergency room visits (26/194 [13.4%] vs. 1/267 [0.4%],p< 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 (p= 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;p< 0.001) and after (OR, 42.012; 95% CI, 5.322–331.632;p< 0.001; E-value = 83.52) propensity score matching.Conclusions: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.
背景：患者运动对放射治疗的精准实施构成重大挑战。接受质子束治疗（PBT）的儿童在6至8周的治疗周期内，可能需要进行多达30次全身麻醉下的治疗。迄今为止，如此多次重复麻醉暴露对患者预后的影响尚不明确。 目的：本研究主要评估基于丙泊酚的全凭静脉麻醉（丙泊酚-TIVA）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天内非计划入院或急诊就诊发生率之间的关联。 方法：本研究为一项回顾性研究，纳入因中枢神经系统疾病接受PBT（无论是否使用麻醉）的儿童（≤19岁）。采用Log-rank检验和Cox比例风险模型进行分析，并使用倾向评分匹配和E值分析来校正选择偏倚。 结果：纳入的461名儿童平均年龄为9.0岁（标准差±4.9）。其中男性占多数，为261/461（56.6%），有267/461（57.9%）的儿童在未使用麻醉的情况下接受了PBT。接受丙泊酚-TIVA麻醉下PBT的患儿年龄更小（4.7岁 vs. 12.2岁，p < 0.001），并且治疗中断（111/194 [57.2%] vs. 118/267 [44.2%]，p = 0.006）、化疗史（64/194 [33.0%] vs. 18/267 [6.7%]，p < 0.001）、同步化疗（37/194 [19.1%] vs. 27/267 [10.1%]，p = 0.006）以及非计划入院/急诊就诊（26/194 [13.4%] vs. 1/267 [0.4%]，p < 0.001）的患者比例更高。两组患者的总生存率（丙泊酚-TIVA组 vs. 无麻醉组）在1年（94% vs. 96%）、2年（88% vs. 90%）和3年（88% vs. 89%）时均相似（p = 0.558）。在多变量分析中，无论在进行倾向评分匹配前（OR，38.311；95%CI，5.139–285.580；p < 0.001）还是匹配后（OR，42.012；95% CI，5.322–331.632；p < 0.001；E值 = 83.52），丙泊酚-TIVA下的PBT均与更高的非计划入院/急诊就诊风险相关。 结论：在这项针对因中枢神经系统疾病接受PBT的儿童的回顾性研究中，基于丙泊酚的全凭静脉麻醉暴露与总生存期之间未发现关联。然而，采用基于丙泊酚的全凭静脉麻醉进行PBT与治疗开始后30天内非计划入院或急诊就诊的风险增加相关。
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