Anthracycline extravasation injuries: management with dexrazoxane

Jordan, Karin; Behlendorf, Timo; Mueller, Franziska; Schmoll, Hans‐Joachim

doi:10.2147/tcrm.s3694

Cited by 34 publications

(34 citation statements)

References 43 publications

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“…In the pivotal trial, in 53 of 54 (98.2%) patients assessable for efficacy, the treatment with dexrazoxane prevented surgery-requiring necrosis [28]. Treatment must be initiated as soon as possible after the extravasation event [52,53,54,55]. The first infusion should be started not later than 6 h following extravasation; infusion should be administered over a period of 1-2 h [53].…”

Section: Resultsmentioning

confidence: 99%

Management of Cytotoxic Extravasation - ASORS Expert Opinion for Diagnosis, Prevention and Treatment

et al. 2013

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Background: Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. Material and Methods: A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. Results: Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. Conclusion: We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.

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Section: Resultsmentioning

confidence: 99%

Management of Cytotoxic Extravasation - ASORS Expert Opinion for Diagnosis, Prevention and Treatment

et al. 2013

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“…Mrs. Zatkó reported complications with "no serious consequences" (but not precisely determined) in case of 0.1 %, but the incidence of all events is not detailed 2 . The risk of extravasation can be reduced significantly by using centrally vein accessed ports and subcutaneously implanted "reservoirs" (subcutaneously implanted ports), but using this method cannot even guarantee to avoid this complication and in addition to the effects of cytostatic agents escaping into the tissues centrally, also unusual complications may develop [5,10,11,[18][19][20][21][22][23][24][25][26][27] .…”

Section: Incidence Of Extravasation and The Possibility Of Risk Incrementioning

confidence: 99%

Overview of extravasation management and possibilities for risk reduction based on literature data

Pikó¹,

Laczó²,

Szatmári³

et al. 2013

JNEP

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Background: The escape of cytostatic drugs from the blood vessels (paravasation, extravasation) during peripheral intravenous administration is a relatively frequent complication; in the United States of America it is reported in seven percent of cases with different severity and consequences. Although methods to completely avoid this complication are still unavailable, we are able to decrease its risk by identifying the patient and procedure-related factors. Methods:In this article the risk factors of extravasation, its prevention possibilities and in case of its development the available treatment choices will be reviewed based on the relevant literature data. Conclusion:The patient -if he/she was adequately informed -is a good indicator of extravasation therefore in case of patient's cooperation was not reliable due to any reason a closer nursing surveillance is required. The severity of tissue injury depends mainly on the chemical structure of the substance escaping from the blood vessels into the surrounding tissues (vesicant, irritant or non-vesicant) which may be modified by other factors as well. There are no high-level evidences available for the management of this complication, immediate discontinuation of the infusion and making an attempt to draw back the escaped drug through the cannula, elevation and immobilization of the affected extremity are required. Literature is contradictory about cooling or warming of the affected area and similarly there are still open questions regarding the value of using antidotes (dexrazoxane, dimethylsulfoxide, thiosulfate and hyaluronidase). If extravasation occurs early referral to dermatologist and surgeon is inevitable for definitive diagnosis and choosing the optimal management.

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“…The extension of destruction depends on the affected location, amount and concentration of the administered agent [2,3,4]. Depending on the kind of agent, extravasation may be treated by local cooling or heating packs, dimethylsulfoxide (DMSO) 99% or hyaluronidase and, if needed, with antibiotics for the prevention of further infection.…”

Section: Introductionmentioning

confidence: 99%

“…However, such surgical interventions may result in significant morbidity. Until recently, no effective conservative treatment had been described for the dreaded accidental anthracycline extravasation [4]. Nowadays, immediate treatment with dexrazoxane, the only proven antidote in the case of accidental anthracycline extravasation, has been implemented into daily clinical practice [1,4,5,7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Until recently, no effective conservative treatment had been described for the dreaded accidental anthracycline extravasation [4]. Nowadays, immediate treatment with dexrazoxane, the only proven antidote in the case of accidental anthracycline extravasation, has been implemented into daily clinical practice [1,4,5,7,8]. Despite topical DMSO, it is the recommended specific antidote to be used as soon as possible (ideally not after 6 h) after anthracycline extravasation, as mentioned in the ESMO-EONS guidelines [9].…”

Section: Introductionmentioning

confidence: 99%

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Complete Recovery of a Wide Local Reaction by the Use of Dexrazoxane 72 Hours after Epirubicin Extravasation: Case Report and Review of the Literature

Aigner¹,

Bauernhofer²,

Petru

et al. 2014

Dermatology

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Background: Accidental extravasation of anthracyclines might result in devastating side effects and complications, including necrosis of tissue, with impairment of neighboring structures - most of them requiring surgery. Following recent approach guidelines, intravenous administration of dexrazoxane within 6 h after the event is recommended. Case Report: We report on a 63-year-old female patient with breast cancer treated with epirubicin combination therapy. She experienced extravasation on the distal right arm at the end of the very first cycle, being initially treated with dimethylsulfoxide 99% topically. Clinical symptoms became worse. Despite the interval between the event and referral, dexrazoxane was given once daily for 3 days. She recovered completely without any sequelae. Conclusion: To our knowledge, this is the first case report of a successful treatment and complete recovery by the use of dexrazoxane even 3 days after extensive epirubicin extravasation. Additionally, a review of the literature is given.

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Anthracycline extravasation injuries: management with dexrazoxane

Cited by 34 publications

References 43 publications

Management of Cytotoxic Extravasation - ASORS Expert Opinion for Diagnosis, Prevention and Treatment

Management of Cytotoxic Extravasation - ASORS Expert Opinion for Diagnosis, Prevention and Treatment

Overview of extravasation management and possibilities for risk reduction based on literature data

Complete Recovery of a Wide Local Reaction by the Use of Dexrazoxane 72 Hours after Epirubicin Extravasation: Case Report and Review of the Literature

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