{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T20:35:41Z","timestamp":1767818141395,"version":"3.49.0"},"reference-count":55,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Proton beam therapy (PBT) is becoming the radiotherapeutic modality of choice for children with curable cancer. A significant proportion require anesthetic care to facilitate precise positioning and immobility, and such patients undergo repetitive episodes of general anesthesia, 5\u2009days a week for up to 8\u2009weeks. Patients with central nervous tumors and those undergoing concurrent chemotherapy form a large proportion of referrals. Although X\u2010ray therapy and PBT demonstrate similarities, factors including younger patient age, longer session length and a need for rigid immobilization, means that providing anesthetic care for PBT is more complex as compared to X\u2010ray therapy. We present a case series of three patients who failed to complete PBT due to problems relating to anaesthesia. Our objective is to highlight specific PBT\u2010related challenges in the pediatric population, because although serious complications are uncommon, there can still be significant risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the patient records of the three pediatric cases that failed to complete PBT at our outpatient regional center between January 2020 and December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two cases failed to complete PBT due to respiratory adverse events, including one that required admission to intensive care. Both of these cases had central nervous tumours. The third case developed neutropenic typhlitis relating to concurrent chemotherapy making the patient unfit for ongoing anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>All three cases demonstrate that the risk of adverse events cannot be reliably predicted in this patient group. Detailed assessment must be performed prior to proceeding with anesthesia including regular review of blood tests, observations, and examining patients for any signs and symptoms of subclinical infection. The decision to proceed with anesthesia on a daily basis will require an anesthetic team that is highly skilled and familiar with their environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anesthetic care for PBT is more complex as compared to X\u2010ray therapy. A small group of children, particularly those with central nervous system tumors or altered respiratory control, may be at increased and sometimes unpredictable risk. Safe and sustainable care for PBT is possible with careful history taking, planning, and identification of patients at a higher risk of adverse events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.70070","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T18:35:54Z","timestamp":1761762954000},"page":"115-121","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Failure to Complete Proton Beam Therapy Relating to Problems With Anesthesia"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1752-0127","authenticated-orcid":false,"given":"Natalie","family":"Blundell","sequence":"first","affiliation":[{"name":"The Christie NHSFT  Manchester 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