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

Aigner, Birgit; Bauernhofer, Thomas; Petru, Edgar; A, Niederkorn; Arzberger, Edith; Richtig, Erika

doi:10.1159/000365391

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…No improvement was slightly more common than improvement , suggesting that skin injuries caused by epirubicin hydrochloride extravasation may be difficult to treat. On the other hand, several reports have indicated that dexrazoxane treats skin injuries caused by anthracycline (epirubicin hydrochloride) extravasation 13,14. Overall, proper extravasation management may reduce skin injuries caused by epirubicin hydrochloride extravasation.…”

Section: Discussionmentioning

confidence: 99%

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Profiles and Outcomes of Skin Injuries Caused by Injectable Drug Extravasation

Maezawa,

Inoue,

Satake

et al. 2023

Journal of Infusion Nursing

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Extravasation occurs when injectable drugs leak out of the blood vessels, damaging the surrounding tissues and causing a variety of skin injuries. This study aimed to comprehensively analyze extravasation risk, skin injury profiles, and outcomes for suspect drugs from the Japanese Adverse Drug Event Report (JADER) database. Adverse events were defined according to the Medical Dictionary for Regulatory Activities/Japanese version; the term extravasation (Standardized MedDRA Query Code: 20000136) was used in this analysis. The names of adverse events were entered as unified preferred terms and redefined to evaluate skin injury profiles. In addition, skin injury outcomes were divided into 2 broad categories: “improvement” and “no improvement.” Reporting odds ratios were used to detect signals for adverse events. A total of 656 cases of extravasation-related adverse events were reported between April 2004 and January 2022. Signals for extravasation-related adverse events were detected from 11 drugs. Then, their respective skin injury profiles and outcomes were determined. These results suggest a relationship between adverse events associated with extravasation and 11 drugs and identify the characteristics of each skin injury and their outcomes. These findings will contribute to improving the quality of infusion management in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…On the other hand, several reports have indicated that dexrazoxane treats skin injuries caused by anthracycline (epirubicin hydrochloride) extravasation. 13,14 Overall, proper extravasation management may reduce skin injuries caused by epirubicin hydrochloride extravasation.…”

Section: Epirubicin Hydrochloride (Anticancer Drug)mentioning

confidence: 99%

Profiles and Outcomes of Skin Injuries Caused by Injectable Drug Extravasation

Maezawa,

Inoue,

Satake

et al. 2023

Journal of Infusion Nursing

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“…These suggest the best treatment is dictated by the class of chemotherapy agent. For vesicants early localisation with a cold compress every 20 minutes, four times a day for 24-48 hours and treatment ideally within 6 hours with intravenous dexrazoxane and topical Dimethyl sulfoxide [10] . This is reflected in several case reports where the systemic use of dexrazoxane has resulted in favorable outcomes during extravasation injury involving central venous catheters [ 11 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Extravasation of Epirubicin chemotherapy from a port-a-cath causing extensive breast necrosis: Sequential imaging findings and management of a breast cancer patient

Moyle

Soh

Healy

et al. 2021

Radiology Case Reports

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Extravasation of chemotherapy is rare with an estimated incidence of 0.01%-7% but can cause significant morbidity, delay in cancer treatment and potential mortality. We present a case of 55-year-old woman with a metastatic right axillary lymph node with no identifiable breast primary, commenced on chemotherapy as per multidisciplinary team decision. Extravasation of 25 mls of Epirubicin chemotherapy at the porta-a-cath (site) caused extensive inflammatory change in the breast parenchyma and chest wall with a necrotic ulcerating skin-defect. Even with ensuring port or peripheral catheter patency and position, extravasation can occur. This is the first case report to describe the use of MRI to help plan management, identifying the extent of the tissue damage and vascular compromise which could impair healing. In this case the necrotic ulcer was managed with surgical debridement and human ADM matrix (Matriderm dermal matrix) which has not been described in the literature previously.

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“…11 Nevertheless, significant clinical improvement has been reported in cases of dexrazoxane being initiated even as late as 72 hours after peripheral extravasation. 17 Dexrazoxane administration can lead to neutropenia, thrombocytopenia and liver enzyme elevation, but these effects were mostly reported with prolonged dexrazoxane use. 11 Dexrazoxane was administered in three cases of intrapleural and mediastinal anthracycline extravasation.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of doxorubicin extravasation into pleural space: Case report and review of literature

Kazakova

Vanegas

Torres

et al. 2020

J Oncol Pharm Pract

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Introduction Intrathoracic extravasation of anthracyclines is a dangerous and very rare complication of chemotherapy administration. While management of extravasation into soft tissues has been established, the data on treatment of mediastinal and intrapleural anthracycline extravasation is limited. Case Report We present a case of a 52-year-old woman with intrapleural doxorubicin extravasation who presented to the hospital 24-hrs after chemotherapy infusion with chest pain and shortness of breath. Management & Outcome The patient underwent urgent surgical intervention and received IV dexrazoxane 36-hrs after the event. Her pain improved, but she continued to have chest soreness and pleural effusion at the site of extravasation even 3 months later. Discussion We conducted review of literature using Medline/PubMed and Google Scholar databases and identified 7 cases of intrapleural and mediastinal anthracycline extravasation. No data is currently available regarding the outcome of delayed management of intrapleural anthracycline extravasation with dexrazoxane. Prevention and confirmation of adequate port catheter placement is the most important step to avoid such cases. Catheter misplacement should be suspected in any patient presenting with post procedural chest pain and should trigger a thorough evaluation prior to any chemotherapy administration.

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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

Cited by 7 publications

References 17 publications

Profiles and Outcomes of Skin Injuries Caused by Injectable Drug Extravasation

Profiles and Outcomes of Skin Injuries Caused by Injectable Drug Extravasation

Extravasation of Epirubicin chemotherapy from a port-a-cath causing extensive breast necrosis: Sequential imaging findings and management of a breast cancer patient

Delayed presentation of doxorubicin extravasation into pleural space: Case report and review of literature

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