Epirubicin extravasation: consequences of delayed management

Hale, O.T.; Deutsch, Peter; Lahiri, A.

doi:10.1136/bcr-2016-218012

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…1,[3][4][5][6]18,19 A reason could be the demanding retrobulbar sinus application route for doxorubicin, a highly tissue-toxic drug. 4,[20][21][22][23] A second difficulty is the importance of the total bioavailability of the injected doxorubicin for the induction of nephrotic syndrome. Differences of just 0.5 mg/g body weight (bw) in the injected dose can cause resistance to model induction, especially in mice.…”

Section: Introductionmentioning

confidence: 99%

Retrobulbar Sinus Injection of Doxorubicin is More Efficient Than Lateral Tail Vein Injection at Inducing Experimental Nephrotic Syndrome in Mice: A Pilot Study

Bohnert

Dörffel²,

Daiminger³

et al. 2019

Lab Anim

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Doxorubicin-induced nephropathy in mice is a model for studying experimental nephrotic syndrome. It corresponds to puromycin aminonucleoside nephrosis in rats. In this model, susceptible 129 S1/SvImJ mice are administered a rapid intravenous injection that can be accomplished via either the lateral tail vein or the retrobulbar sinus. Because doxorubicin is a highly toxic substance, extravasation must be avoided during the administration of the intravenous injection to prevent the development of large necrotizing lesions and exacerbation of the animals’ stress. In the present study, we compared the safety and stress of these two injection routes by using histopathological analyses of the animals’ orbital cavities or tails, respectively. The injection of 14.5 µg/g body weight doxorubicin into the mice’s lateral tail veins ( n = 9) or retrobulbar sinuses ( n = 19) caused no clinically detectable stress or impairment. Histopathologies of the specimens five days after doxorubicin injection revealed inflammatory lesions at the injection sites in both groups. In the orbital sinus specimens from the retrobulbar-injected group, fibrosis was evident 25 days after injection. Moreover, while all of the retrobulbar-injected mice (100%) developed nephrotic syndrome, tail vein-injected mice had a significantly lower response rate (66%, p = 0.047, Fisher’s exact test) and exhibited only attenuated features of nephrotic syndrome. It was therefore concluded that doxorubicin administration via either lateral tail vein or retrobulbar sinus injections led to a similar induction of histopathological changes with no effects on the clinical well-being of the mice. However, retrobulbar sinus injections were more efficient for inducing experimental nephrotic syndrome.

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Section: Introductionmentioning

confidence: 99%

Retrobulbar Sinus Injection of Doxorubicin is More Efficient Than Lateral Tail Vein Injection at Inducing Experimental Nephrotic Syndrome in Mice: A Pilot Study

Bohnert

Dörffel²,

Daiminger³

et al. 2019

Lab Anim

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“…The authors insist on immediate placement at the beginning of the procedure of 2 stitches on the fascia to guarantee tightness and to prevent leakage of the toxic aerosol with possible infiltration of the subcutaneous tissue. During PIPAC, drugs (such as anthracyclines) are used that are feared for inducing tissue necrosis in the case of extravasation [12]. Thus, it is potentially hazardous to achieve tightness with skin closure rather than fascial closure, since intraabdominal pressure might then force the toxic aerosol into the subcutaneous tissue [11].…”

Section: Resultsmentioning

confidence: 99%

Staging laparoscopy and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastasis: safe access to the abdomen

Glatz

Horvath

Lang

et al. 2019

Pleura and Peritoneum

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BackgroundPressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is an innovative drug delivery technique. Most common indication is palliative therapy of peritoneal metastasis of gastrointestinal and gynecological origin in the salvage situation. Access to the abdomen is the critical step of the procedure, since most patients had previous surgery. Potential pitfalls include non-access because of adhesions, bowel access lesions and postoperative subcutaneous toxic emphysema.MethodsWe propose a technique, the “finger-access technique” that might prevent largely these pitfalls. A minilaparotomy of 3 cm is performed in the midline, a finger introduced into the abdomen and a 5-mm double-balloon trocar (no Hasson trocar) is placed under finger protection at some distance of the first incision. The fascia of the minilaparotomy, not the skin, is then closed. The abdomen is insufflated with CO2 and tightness is controlled with saline solution in the minilaparotomy. A second 10–12 mm trocar is then introduced under videoscopic control. The first trocar is then visualized through the second one to exclude a bowel lesion during first access.Results and conclusionsIn our hands, this access technique has shown to be safe and effective.

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“…Extravasation is a serious complication of chemotherapeutic agents administered intravenously, and it is vital that signs of extravasation are recognized promptly and treated immediately. These signs include sensory changes, pain, swelling, blanching and erythema [3] . The consequences of extravasation can range from pain, delay in treatment, impairment of mobility and psychological distress from the extensive tissue damage.…”

Section: Discussionmentioning

confidence: 99%

“…The consequences of extravasation can range from pain, delay in treatment, impairment of mobility and psychological distress from the extensive tissue damage. Certain patient factors may be associated with a greater risk of extravasation such as age, underlying vascular disease, and history of multiple intravenous therapies [3] . A high body mass index has been shown to be associated with all the patients that experienced extravasation in a study by Halsik [4] .…”

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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Epirubicin extravasation: consequences of delayed management

Cited by 7 publications

References 9 publications

Retrobulbar Sinus Injection of Doxorubicin is More Efficient Than Lateral Tail Vein Injection at Inducing Experimental Nephrotic Syndrome in Mice: A Pilot Study

Retrobulbar Sinus Injection of Doxorubicin is More Efficient Than Lateral Tail Vein Injection at Inducing Experimental Nephrotic Syndrome in Mice: A Pilot Study

Staging laparoscopy and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastasis: safe access to the abdomen

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

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