Abstract
The majority of chemotherapy regimens and trials specify doses of cytotoxic drugs normalized to body surface area. Estimation of BSA in paediatric patients is particularly problematic, as conventional nomograms require accurate determination of both height and weight. The chemotherapy standards group of the UKCCSG (United Kingdom Children's Cancer Study Group) has evaluated a method for calculation of body surface area (BSA) estimation, based solely on patient weight. In comparison with BSA estimations using 2 commonly used methods, which require both weight and height measurements, deviation in the estimate of BSA was less than 10%. This method may be extended to the dosing of chemotherapeutic agents in infants of body weight less than 10 kg, with appropriate recommendations for dose modification. Until better correlates of drug clearance, such as GFR for carboplatin, are identified BSA is used to standardize doses for most chemotherapeutic agents. The formula presented here provides a more robust and reliable method of calculation of BSA from weight alone. Although this approach has been shown to be equivalent to other currently used methods, care should be taken extending this calculation of BSA to children less than 10 kg, to obese patients and to those with cachexia. © 2001 Cancer Research Campaign http://www.bjcancer.com
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Blanco JG, Harrison PL, Evans WE and Relling MV (2000) Human cytochrome P450 maximal activities in pediatric versus adult liver. Drug Metab Disp 28: 379–382
Boos J, Krumpelmann S, Sculze-Westhoff P, Euting T, Berthold F and Jurgens H (1995) Steady state levels and bone marrow toxicity of etoposide in children and infants. Does etoposide require age-dependent dose calculation. J Clin Oncol 13: 2954–2960
Boyd E (1935). Surface Area of the Human Body,
Briars GL and Bailey BJR (1994) Surface area estimation: Pocket calculator v nomogram. Archives of Disease in Childhood 70: 246–247
Calvert AH, Newell DR, Gumbrell LA, O’Reilly S, Burnell M, Boxall FE, Siddik ZH, Judson IR, Gore ME and Wiltshaw E (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7: 1748–1756
Coulthard MG (1994) Surface area is best estimated from weight alone: Pocket calculators and nomograms are unnecessary. Archives of Disease in Childhood 71: 281
Crom WR, Glynn-Barnhart AM, Rodman JH, Teresi ME, Kavanagh RK, Christensen ML, Relling MV and Evans WE (1987) Pharmacokinetics of anticancer drugs in children. Clin Pharmacokin 12: 168–213
Crom WR, Relling MV, Christensen ML, Rivera GK and Evans WE (1991) Age-related differences in hepatic drug clearance in children: Studies with lorazepam and antipyrine. Clin Pharmacol Ther 50: 132–140
Desoize B and Robert J (1994) Individual dose adaptation of anticancer drugs. Eur J Cancer 30A: 844–851
DuBois D and DuBois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Archives of Internal Medicine 17: 863–871
Evans WE, Relling MV, Rodman JH, Crom WR, Boyett JM and Ching-Hon P (1998) Conventional compared with individualised chemotherapy for childhood acute lymphoblastic leukemia. N Eng J Med 338: 499–505
Friss-Hansen B (1961) Body water compartments in children; changes during growth and related changes in body composition. Pediatrics 28: 169–181
Galpin A and Evans W (1993) Therapeutic drug monitoring in cancer management. Clin Chem 39: 2419–2430
George SL and Gehan EA (1979) Methods for measurement of body surface area. Journal of Pediatrics 94: 342–343
Gurney H (1996) Dose calculation of anticancer drugs: a review of the current practice and introduction of an alternative. J Clin Oncol 14: 2590–2611
Haycock GB and Schwarz GJ (1978) Geometric method for measuring body surface area. A height-weight formula validated in infants. J Paed 93: 62–66
McLeod HL, Relling MV, Crom WR, Silverstein K, Groom S, Rodman JH, Rivera GK, Crist WM and Evans WE (1992) Disposition of antineoplastic agents in the very young child. Br J Cancer 66: S 23–S 29
Mosteller RD (1987) Simplified calculation of body surface area. N Eng J Med 317: 1098
Newell DR, Pearson ADJ, Balmanno K, Price L, Wyllie RA, Kier M, Calvert AH, Lewis IJ, Pinkerton CR and Stevens MCG (1993) Carboplatin pharmacokinetics in children: the development of a pediatric dosing formula. J Clin Oncol 11: 2314–2323
Pinkel D (1958) The use of body surface area as a criterion of drug dosage in cancer chemotherapy. Cancer Res 18: 853
Ratain MJ (1998) Body-surface area as a basis for dosing of anticancer agents. J Clin Oncol 16: 2297–2298
Reaman GH (1993) Special consideration for the infant with cancer. Principles and Practise of Paediatric Oncology Pizzo PA and Poplack DG (eds) pp. 303–314. J.B. Lippincott Company: Philadelphia, Pa
Sendroy J and Cechini LP (1952) Determination of human body surface area from height and weight. Journal of Applied Physiology 7: 1–12
Smith JM (1996) Dangers of algorithms. Pharmaceutical Journal 257: 136
Woods WG, O’Leary M and Nesbitt ME (1981) Life-threatening neuropathy and hepatotoxicity in infants during induction therapy for acute lymphoblastic leukemia. Journal of Pediatrics 98: 642–645
Author information
Authors and Affiliations
Consortia
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Sharkey, I., Boddy, A., Wallace, H. et al. Body surface area estimation in children using weight alone: application in paediatric oncology. Br J Cancer 85, 23–28 (2001). https://doi.org/10.1054/bjoc.2001.1859
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1054/bjoc.2001.1859
This article is cited by
-
Optimizing the corticosteroid dose in steroid-sensitive nephrotic syndrome
Pediatric Nephrology (2022)
-
High-dose versus low-dose intravenous immunoglobulin for treatment of children with Kawasaki disease weighing 25 kg or more
European Journal of Pediatrics (2020)
-
Population pharmacokinetics of treosulfan and development of a limited sampling strategy in children prior to hematopoietic stem cell transplantation
European Journal of Clinical Pharmacology (2018)
-
Treosulfan Pharmacokinetics and its Variability in Pediatric and Adult Patients Undergoing Conditioning Prior to Hematopoietic Stem Cell Transplantation: Current State of the Art, In-Depth Analysis, and Perspectives
Clinical Pharmacokinetics (2018)
-
Virtual Clinical Studies to Examine the Probability Distribution of the AUC at Target Tissues Using Physiologically-Based Pharmacokinetic Modeling: Application to Analyses of the Effect of Genetic Polymorphism of Enzymes and Transporters on Irinotecan Induced Side Effects
Pharmaceutical Research (2017)