Abstract
Purpose
In a longitudinal observation, extravasation of antitumoural compounds and the efficacy of its structured interdisciplinary management were assessed in a routine setting.
Methods
One hundred sixty-nine patients with extravasation of cytotoxics were managed according to a prospective approach documenting the extravasated compound, localisation, duration until full symptom resolution and sequelae. Surgery was implemented in the case of failure of conservative measures.
Results
In 155 (91.7 %) out of 169 patients, conservative management was successful (surgical intervention, 14 patients). Extravasations of anthracyclines (N = 44), platinum compounds (N = 41), vinca alkaloids (N = 20) and taxanes (N = 19) were often associated with erythema, oedema and pain. The median period until full resolution of symptoms differed among the administered cytotoxics (anthracyclines, 55 days; taxanes and vinca alkaloids, 27 days; platinum compounds, 14 days) with statistical significance between the vesicants. Histologically, surgically resected specimens showed extensive necrotic areas with inflammatory infiltrates at the periphery of the removed lesions.
Conclusions
In a routine setting, the standardised management of cytotoxic extravasations by an interdisciplinary task force resulted in a satisfactory outcome. When surgical intervention was indicated, complete remission of the lesions within a median of 14 days reduced the delay in the administration of further chemotherapy to a minimum. The proposed approach is therefore considered as suitable to manage extravasations in cancer chemotherapy in a large number of subjects and to ensure patient adherence to cytotoxic treatment.
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References
Rudolph R, Stein RS, Pattillo RA (1976) Skin ulcers due to adriamycin. Cancer 38:1087–1094
Ignoffo RJ, Friedman MA (1980) Therapy of local toxicities caused by extravasation of cancer chemotherapeutic drugs. Cancer Treat Rev 7:17–27
Larson DL (1982) Treatment of tissue extravasation by antitumor agents. Cancer 49:1796–1799
MacCara ME (1983) Extravasation: a hazard of intravenous therapy. Drug Intell Clin Pharm 17:713–717
Krämer I (2002) Ten years documentation of cytotoxic extravasations: results from 175 documented cases [translation from German]. Krankenhauspharmazie 23:269–274
Bertelli G, Gozza A, Forno GB, Vidili MG, Silvestro S, Venturini M, Del Mastro L, Garrone O, Rosso R, Dini D (1995) Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study. J Clin Oncol 13:2851–2855
Madhavan S, Northfelt DW (1995) Lack of vesicant injury following extravasation of liposomal doxorubicin. J Natl Cancer Inst 87:1556–1557
Stanley A (2002) Managing complications of chemotherapy administration. In: Allwood M, Stanley A, Wright P (eds) The cytotoxics handbook. 4th edn. Radcliffe Medical Press, pp 119–193
Bertelli G, Cafferata MA, Ardizzoni A, Gozza A, Rosso R, Dini D (1997) Skin ulceration potential of paclitaxel in a mouse skin model in vivo. Cancer 79:2266–2269
Mader I, Furst-Weger P, Mader RM, Nogler-Semenitz E, Wassertheurer S (2010) Extravasation of cytotoxic agents, 2nd edn. Springer, Wien New York
Theman TA, Hartzell TL, Sinha I, Polson K, Morgan J, Demetri GD, Orgill DP, George S (2009) Recognition of a new chemotherapeutic vesicant: trabectedin (ecteinascidin-743) extravasation with skin and soft tissue damage. J Clin Oncol 27:e198–e200
Bhawan J, Petry J, Rybak ME (1989) Histologic changes induced in skin by extravasation of doxorubicin (adriamycin). J Cutan Pathol 16:158–163
Upton J, Mulliken JB, Murray JE (1979) Major intravenous extravasation injuries. Am J Surg 137:497–506
Linder RM, Upton J, Osteen R (1983) Management of extensive doxorubicin hydrochloride extravasation injuries. J Hand Surg [Am] 8:32–38
Haslik W, Pluschnig U, Steger GG, Zielinski CC, Schrogendorfer KF, Nedomansky J, Bartsch R, Mader RM (2014) Indocyanine green video angiography predicts outcome of extravasation injuries. PLoS ONE 9:e103649
Mouridsen HT, Langer SW, Buter J, Eidtmann H, Rosti G, de Wit M, Knoblauch P, Rasmussen A, Dahlstrom K, Jensen PB, Giaccone G (2007) Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol 18:546–550
Langer SW, Thougaard AV, Sehested M, Jensen PB (2006) Treatment of anthracycline extravasation in mice with dexrazoxane with or without DMSO and hydrocortisone. Cancer Chemother Pharmacol 57:125–128
Bertelli G, Dini D, Forno GB, Gozza A, Silvestro S, Venturini M, Rosso R, Pronzato P (1994) Hyaluronidase as an antidote to extravasation of Vinca alkaloids: clinical results. J Cancer Res Clin Oncol 120:505–506
Fields S, Koeller J, Topper RL, Guritz G, Von Hoff D (1990) Local soft tissue toxicity following cisplatin extravasation. J Natl Cancer Inst 82:1649–1650
Herrington JD, Figueroa JA (1997) Severe necrosis due to paclitaxel extravasation. Pharmacotherapy 17:163–165
Askar I, Erbas MK, Gurlek A (2002) Effects of heparin fractions on the prevention of skin necrosis resulting from adriamycin extravasation: an experimental study. Ann Plast Surg 49:297–301
Rudolph R, Suzuki M, Luce JK (1979) Experimental skin necrosis produced by adriamycin. Cancer Treat Rep 63:529–537
Luedke DW, Kennedy PS, Rietschel RL (1979) Histopathogenesis of skin and subcutaneous injury induced by adriamycin. Plast Reconstr Surg 63:463–465
Petro JA, Graham WP 3rd, Miller SH, Overholt T, Fallon T (1979) Experimental and clinical studies of ulcers induced with adriamycin. Surg Forum 30:535–537
Dorr RT, Alberts DS, Chen HS (1980) The limited role of corticosteroids in ameliorating experimental doxorubicin skin toxicity in the mouse. Cancer Chemother Pharmacol 5:17–20
Acknowledgments
We are grateful to Christoph Kornauth for his contribution to the histopathological examination of resected specimens. The authors would also like to acknowledge the valuable contribution of Simone Messner who provided the infusion statistics of the General Hospital/University Clinics Vienna.
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We declare that we have no conflict of interest.
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Pluschnig, U., Haslik, W., Bayer, G. et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer 23, 1741–1748 (2015). https://doi.org/10.1007/s00520-014-2535-2
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DOI: https://doi.org/10.1007/s00520-014-2535-2