 |
| Radiotherapy without anesthesia for patient Thai M. A. |
Special radiation therapy room
Radiotherapy room – where the Elekta Synergy linear accelerator system with 160 new-generation leaves is installed – is quiet, with only cheerful sounds coming from a smartphone. Little Thai M. A. (5 years old, from Nghe An) lies still watching cartoons on the phone, hugging tightly a small pink teddy bear she loves, preparing for her radiation session. A nurse reassures her, “Good girl, just lie still for a few minutes, and it will be over soon”!... This is a familiar scene with pediatric radiation cases. In addition to treatment, comforting and calming the children’s minds plays an equally important role.
Outside the waiting room, Ms. Duong T. S., M. A.'s mother, anxiously paced back and forth, even though her child had undergone radiotherapy many times and was nearing the end of the treatment regimen. M. A. was diagnosed with diffuse intrinsic pontine glioma (DIPG) – a “high-grade” malignant brain tumor. This tumor is in a dangerous area, making surgical removal impossible. As such, radiotherapy is the current standard treatment recommended by specialists. Being a doctor working in Central Vietnam, Ms. M. S. decided to bring her child to Hue after the diagnosis at Viet Duc Friendship Hospital (Hanoi). When they first arrived, M. A. was admitted to the Pediatric Intensive Care Unit in a semi-conscious state, suffering from headaches, vomiting, and right-side hemiplegia. After nearly two months of radiotherapy, the child's condition improved significantly – she became alert, could talk to her family, and underwent physical rehabilitation. Ms. S. shared: “I consulted with professors and thoroughly researched the options. Knowing that Hue Central Hospital has some of the most advanced equipment in the country, along with a team of highly skilled and experienced doctors in pediatric radiation therapy, and that many hospitals refer difficult cases here, our family immediately brought her to Hue to seek a chance for her survival.”
 |
| The team monitors the pediatric radiotherapy case via a camera system from outside. |
Following M. A.'s session was Bui Thi T. N., a child not yet 2 years old, the youngest patient in the radiotherapy session that morning. The team had to administer anesthesia to ensure precision during the procedure. Once the radiotherapy was completed, as she was removed from the machine, the child woke up, opened her eyes, and cried for her mother. At 10 months old, T. N.’s abdomen began to swell abnormally, prompting her family to take her to the Vietnam National Children's Hospital, where she was diagnosed with soft tissue sarcoma – a complex, highly malignant type of cancer. After undergoing chemotherapy and surgery, she was transferred to Hue Central Hospital for radiotherapy. Ms. Bui T. Th., T. N.'s mother, shared: “The doctors in Hanoi advised us to come to Hue because they specialize in pediatric radiotherapy. After just a few sessions, her health has shown clear improvement – she eats well, vomits less, and receives thorough care from the medical team, which gives us great peace of mind.”
Unlike anesthesia in the operating room, anesthesia for radiotherapy always carries potential risks, with complications that can occur at any time. While monitoring indirectly via the camera system from outside, doctors detected a sudden oxygen drop in a 6-year-old pediatric patient undergoing radiotherapy under anesthesia. The sound of rushing footsteps entering the radiation room for intervention and urgent shouts filled the air. Witnessing the scene, the child’s mother, distraught, clasped her hands in front of her chest, silently praying.
All for the pediatric patients
Most pediatric patients referred for radiation therapy at Hue Central Hospital are severe and complex cases. During radiotherapy, children are required to remain still for 15–20 minutes, as even the slightest movement can cause the radiation beam to miss the tumor target. Dr. Ngo Dung, MD, PhD, Head of the Anesthesia and Resuscitation Department B, stated that administering anesthesia to children with cancer during radiotherapy is truly an art. “There is no universal formula here; it must be tailored to each patient’s condition and the nature of their disease. The recovery area of the Anesthesia Department, located right next to the radiotherapy area, facilitates the process of pediatric radiation therapy under anesthesia. After the radiation session, the child is brought to the recovery area, where the mother is allowed to interact with the child early on to provide comfort and reassurance,” Dr. Ngo Dung explained.
A radiation treatment course for children typically involves 10-30 sessions. If anesthesia is required during the radiation treatment, the number of anesthesia sessions corresponds to the number of radiation sessions. Anesthesia is a challenge for radiation centers. For this reason, hospitals across the country are quite cautious when it comes to treating children with radiation, especially when anesthesia is involved. Despite facing many challenges, leaders at Hue Central Hospital are determined to implement this method, as there is a need for a quality and reputable radiation treatment facility for children. Over the past 10 years, pediatric radiation treatment at Hue Central Hospital has made significant progress towards achieving the best quality, the most accurate standards, and the timeliest service, becoming a trusted destination for patients nationwide. Even large centers that treat pediatric cancer, such as the Vietnam National Children’s Hospital, Children’s Hospital 1, K Hospital in Hanoi, and the Oncology Hospital in Ho Chi Minh City, refer difficult cases that require radiation treatment, especially those needing anesthesia, for online consultations and also refer children to Hue Central Hospital for radiation therapy.
According to experts, pediatric oncology is completely different from adult oncology, requiring multimodal treatment, including chemotherapy, surgery, radiation therapy, immunotherapy, rehabilitation, etc... To implement pediatric radiotherapy, doctors specializing in adult radiotherapy need additional training both domestically and internationally, with continuous education in pediatric oncology and pediatric radiotherapy. Additionally, a well-coordinated team must be established, including pediatric radiation oncologists and nurses, physicists and technicians specializing in pediatric radiotherapy, anesthesiologists and technicians for anesthesia and recovery, rehabilitation specialists, and other support groups.
“Doctors and medical staff working in pediatric radiotherapy teams are those who dare to commit and sacrifice for their patients,” said Dr. Phan Canh Duy, Deputy Director of the Oncology Center and Head of Radiation Department 2. “We are fortunate to receive support from colleagues treating pediatric cancer across the country, helping one another learn and exchange knowledge to gain deeper insights into this field. This enables us to conduct pediatric radiotherapy in accordance with national and international treatment protocols,” Dr. Duy added.
Building on the existing foundation, the Board of Directors at Hue Central Hospital has made significant investments in workforce training and specialized equipment to advance pediatric radiotherapy, especially anesthetized radiotherapy. The new-generation, high-quality radiotherapy machine of the hospital is capable of performing advanced radiotherapy techniques, delivering optimal radiation doses to treatment targets while minimizing exposure to healthy tissues surrounding the tumor, thereby reducing the side effects of radiotherapy (such as Intensity-Modulated Radiotherapy - IMRT, Volumetric Modulated Arc Therapy - VMAT, and Image-Guided Radiotherapy - IGRT). The quality of radiotherapy is on par with regional countries such as Thailand and Singapore. Treatment protocols are agreed upon and unified within the Asia-Pacific group.
In 2023, the Radiation Department 2 of the Oncology Center at Hue Central Hospital conducted 1,000 anesthesia-assisted radiotherapy sessions for children. In 2024, nearly 150 pediatric patients from all over the country underwent radiotherapy (including over 1,100 anesthesia-assisted radiotherapy sessions for 50 cases). According to Professor Pham Nhu Hiep, Director of Hue Central Hospital, the facility is one of only two hospitals in the country capable of performing anesthesia-assisted radiotherapy for pediatric patients.
“We are a comprehensive multidisciplinary hospital with all specialized departments. In addition to the Oncology Center, we also have the Pediatric Oncology Department and surgical departments related to pediatric surgery. This ensures comprehensive treatment from surgery, chemotherapy, and stem cell transplantation to radiotherapy.”, affirmed the Director of Hue Central Hospital.