The use of general anaesthesia in paediatric radiotherapy

Radiotherapy plays a key role in the management of paediatric cancers. Over the past few years there has been a steady decline in the use of radiation as concerns over long-term side effects have become apparent and the use of chemotherapy has expanded. That said, radiotherapy still plays a major part in the management of brain tumours, haematological malignancies, soft tissue tumours and in the palliation of symptoms.As the technology behind radiotherapy has advanced, this has enabled an increase in the conformity of radiation and therefore higher dose delivery to the tumour and reduction in the radiation received by normal tissues and organs at risk. A consequence of increased beam conformity is a greater need to ensure accuracy of patient position and limit movement during treatment. Achieving this can be particularly challenging with children due to their age, understanding of the situation, and ultimately their ability to comply with a treatment process that is quite daunting.The use of general anaesthesia within radiotherapy is not a new concept and it is widely acknowledged as being a safe and effective method of immobilising children. This paper presents a systematically undertaken review of the literature related to radiotherapy, general anaesthesia and play preparation within paediatric radiotherapywith specific emphasis on the role of general anaesthesia in achieving immobilization of patient position.