Safety and cost-effectiveness of outpatient total body irradiation in pediatric patients undergoing stem cell transplantation.
OBJECTIVE
To determine the feasibility, safety, and cost of delivering total body irradiation (TBI) in an outpatient setting.


METHODS
The records of 33 pediatric patients with hematopoietic malignancies undergoing TBI in preparation for bone marrow transplantation (BMT) at the Children's Medical Center of Dallas between February 1992 and June 1997 were retrospectively reviewed. Seventeen children received TBI in an outpatient setting, including 7 patients younger than 8 years of age. All patients had a good performance status (Karnofsky index > 90%) and lived or were housed within a 50-mile radius of the hospital. Patients received 1200 cGy or 1350 cGy in 8 or 9 fractions twice daily over 4 to 5 days and were admitted for high-dose chemotherapy after the last TBI fraction. Mean age was 9 years (range 13 months to 16 years). Close contact was maintained with the BMT staff during outpatient TBI.


RESULTS
Eleven patients (65%) received oral ondansetron for nausea and vomiting, 6 received promethazine and ondansetron, and 3 required dexamethasone. Only 2 of the 17 children (12%) required admission during TBI for persistent vomiting and poor oral intake. Two other children (12%) required outpatient administration of intravenous fluids. The other 13 patients (76%) tolerated the outpatient TBI regimen well. Taking into account hospitalization and ambulance transport charges, outpatient TBI represented a savings of approximately $3250 per patient compared with inpatient TBI.


CONCLUSIONS
Fractionated TBI delivered in an outpatient setting to selected children of all ages is a safe and cost-effective practice.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235, USA.
R A
RA
Farah
V M
VM
Aquino
L L
LL
Munoz
E S
ES
Sandler
D000208:Acute Disease; D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D019583:Dose Fractionation, Radiation; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000188:drug therapy / Q000191:economics / Q000532:radiotherapy / Q000628:therapy*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000191:economics / Q000532:radiotherapy / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects / Q000191:economics