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Radiation Therapy without Anesthesia for a 2-Year Old Child using Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR). Practical radiation oncology Prasad, R. N., Baliga, S., Banner, J., Cadieux, C., Centnar, A., Degnan, M., Depinet, M., Ewing, A., Hobbs, N., Jiang, A. L., Manring, I., Perlow, H. K., Rock, A., Skinner, L. B., Tenney, L., Walls, V., Hiniker, S. M., Palmer, J. D. 1800

Abstract

Radiation therapy (RT) is essential to managing many pediatric malignancies, but can be anxiety, fear, and discomfort provoking for children due to prolonged treatment time, extended course, and restrictive immobilization. Patients under 10 years frequently require daily general anesthesia (GA), which is resource intensive, expensive, potentially toxic, and anxiety/fear provoking. The Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR), a video streaming device, has been proposed as an alternative to anesthesia in patients aged 3-10. A pilot study evaluating the efficacy of this novel innovation is accruing, but patients under 3 are ineligible. We simulated a 2-year-old with Stage IV Wilms tumor for bilateral whole lung and left flank irradiation without GA. Using the AVATAR, we attempted to deliver RT to this patient without sedation. Patient anxiety at the time of simulation and at the beginning, middle, and end of the treatment course was characterized using the validated Modified Yale Preoperative Anxiety Score (mYPAS) measurement tool. Although the patient tolerated CT simulation without GA or AVATAR use, his mYPAS of 14/18 indicated significant anxiety. Using the AVATAR, all treatments were delivered without GA; mYPAS scores were 5, 4 (lowest possible), and 4 at the first, mid-course and final treatments, indicating no significant anxiety and a decrease from pre-AVATAR baseline. Without GA, the package time to deliver RT decreased by 66% from 90 to 30 minutes. In summary, we describe an expanded, previously unreported indication for the AVATAR by demonstrating the feasibility of this anesthesia-reducing/omitting approach in appropriate younger patients currently excluded from ongoing trials. The financial and quality of life benefits (including decreased stress, anxiety, toxicity, cost, and appointment time) of AVATAR utilization may be extendable to a younger patient population than previously thought. In older children, prospective validation is ongoing, but additional study in patients under 3 is needed.

View details for DOI 10.1016/j.prro.2021.12.009

View details for PubMedID 34971793