Impact of Pediatric Radiation Oncology With Movie Induced Sedation Effect (PROMISE) on Patient Movement and General Anesthesia Use in Pediatric Radiation Therapy

Abstract

Pediatric radiation therapy (RT) often requires daily anesthesia to ensure precise immobilization for safe and accurate treatment. Unfortunately, repeated anesthesia can be detrimental to patient health and quality of life, and provides significant logistical and financial burden. PROMISE (Pediatric Radiation Oncology with Movie Induced Sedation Effect) is an interactive incentive-based movie system that allows for real time monitoring of patient motion and automatic shutting off of the beam and video if the patient moves outside of defined parameters. We hypothesize that PROMISE will result in minimal patient movement during RT and an overall decrease in the need for general anesthesia in young children (ages 3-7).PROMISE integrates a movie system involving wireless video streaming to a low attenuation screen directly in front of the patient with a video surveillance gating module (AlignRT) for real time monitoring and behavior training. Starting in the beginning of 2020, this system was available for all children < 12 years old undergoing RT at our institution. For patients treated with PROMISE, AlignRT monitoring data was collected and analyzed to determine patient motion. We compared frequency of anesthesia use after implementation of PROMISE to the 2 years' prior at our institution to estimate reduction in anesthesia use per age group.PROMISE was successfully implemented in 21 children, the majority (76%) who were 7 years or younger and most likely would have otherwise required daily anesthesia. Patient movement during RT with PROMISE was minimal, with in-treatment variation of ∼1.2 mm (0.8 mm standard deviation) from the reference baseline. Prior to implementation of PROMISE (2018-19), 100% of kids below the age of 3 (6/6), 70% of kids ages 3-7 (14/20), and 14% of kids ages 8 to 11 (4/28) needed general anesthesia. After PROMISE implementation (2020), 100% of kids below the age of 3 (5/5), 40% of kids ages 3-7 (8/20), and 8% of kids ages 8-11 (1/13) needed general anesthesia. When analyzed per fraction, after PROMISE, 100% below the age of 3 (76/76), 29% ages 3-7 (90/315), and < 1% ages 8-11 (1/221) required general anesthesia. On per patient comparison, PROMISE resulted in a 30% absolute benefit in those 3-7 years old, with 70% previously requiring anesthesia to only 40% after the implementation of PROMISE.PROMISE resulted in a 30% absolute reduction in general anesthesia use for children ages 3-7. Further, patient movement during RT with PROMISE was minimal, within acceptable standards. The real time motion monitoring with automatic safety shutoff and behavioral training make PROMISE a unique and attractive alternative to general anesthesia. Further prospective clinical data is necessary to prove the safety and efficacy of PROMISE in pediatric RT.