Patterns of Treatment Gaps and Opportunities for Advancement of Pediatric Radiation Therapy Services in Tertiary Care University Hospital in Pakistan - A Retrospective Audit

Abstract

<h3>Objectives</h3> The aim of this study was to review pattern of treatment gap for pediatric patients treated with radiation therapy at our university hospital and identify the reasons for treatment interruptions. <h3>Methods</h3> Hospital database was reviewed for individual treated with radiation therapy(RT) on pediatric treatment protocol or age between 0-18years from January 2009-March 2021 with or without general anesthesia(GA). Patients were identified who had treatment gap of one or more days during RT delivery. Data for demographic details, diagnosis, region of treatment, duration of gap and reason for treatment interruption were recorded and analyzed. <h3>Results</h3> Out of 511 patients treated from January,2009-March,2021, there were 178 events of treatment gap recorded in 118 patients. The mean age of patients was 8.2years [± 4.95, (1-19years)] and 71(60%) them were male. Eighty one patients (75%) were referred from another institute for radiotherapy. All cases were discussed in tumor board and RT plans were peer-reviewed. Most of these patients were treated for sarcomas 57%(67 patients), CNS 15%(16 patients), lymphomas 14%(16 patients) and renal tumors 10%(12%) patients. Duration of treatment gap was 1-2days in 40(34%) patients, 2-7days in 42(36%) patients and ≥8days in 36(30%) patients. Major reasons included in-patient admission due to fever, neutropenia or diarrhea in 53 patients, machine breakdown in 29 patients, refusal of anesthesia fitness due to chest congestion in 24 patients, patients' social reason in 14 and RT re-planning in 10 patients. Out of 118 patients, 45(38%) were being treated under GA and 73(62%) without GA. 24 of 45 patients treated under GA had treatment interruption because of being unfit for GA before RT. Patients treated under GA also had longer duration of interruption, 36% having 3-7days gap and 42% having total gap of ≥8days. <h3>Conclusion</h3> These finding domonstrate potenial areas of improvement through active monitorying and supportive care during treatment and equipment maintenance to avoid interruptions, hence to achieve optimal local control with radiotherapy. Special attention is required for general anesthesia and corrdination with pediatric oncologist.