What is the most common route for initial chemotherapy administration in pediatric oncology, and why is it preferred?

• A. Oral administration for convenient dosing.
• B. Intravenous administration via central venous access to ensure reliable delivery and safe vesicant administration.
• C. Subcutaneous injection to minimize invasiveness.
• D. Intramuscular injection to maximize absorption.

Answer: (B)

Starting chemotherapy in children is most often done through intravenous delivery via a central venous access device. This method provides reliable and precise drug delivery, which is crucial for dosing accuracy across complex pediatric regimens. It also accommodates large or highly concentrated solutions and enables the safe administration of vesicant drugs that can cause severe tissue injury if they escape from a peripheral vein. A central line minimizes the need for repeated needle sticks, supports frequent infusions and blood draws, and reduces irritation and damage to peripheral veins over the course of long or intensive treatment.

Oral administration isn’t typically used for initial chemotherapy due to variable and often limited bioavailability of many cytotoxic agents, making dosing unreliable. Subcutaneous and intramuscular routes have limited absorption and are not suitable for the volumes and infusion patterns required for most chemotherapy regimens, especially when vesicants are involved.