Management of Anthracycline Extravasation Injuries

Abstract

OBJECTIVE: To review the evidence for the management of anthracycline extravasation and determine the optimal treatment of such injuries.

Successful dexrazoxane treatment of a potentially severe extravasation of concentrated doxorubicin

“…Vesicant drugs can cause blistering and tissue destruction; irritant drugs can induce pain at the injection site and inflammation without necrosis; and nonaggressive drugs rarely cause any reaction [5,6]. The severity of tissue injury is dependent on the drug concentration and the injected quantity of the chemotherapeutic agent [7].…”

Comment on: management of chemotherapy extravasation: ESMO–EONS clinical practice guidelines

“…The majority of human data on anthracycline extravasations treatment include the use of dimethyl sulfoxide (DMSO) 99% combined with cooling or dexrazoxane [4]. These agents were included as treatment options in extravasations occurred during anthracycline treatment with the same grade of recommendation (IIIB) [1].…”

“…Surprisingly, Table 5 lowered the level of recommendation of topical DMSO treatment to IV-B, without referencing in the main text or further explanation. We understand that both agents must have the same grade of recommendation due to similar efficacy rates and experience described in the literature [1,4]. A strong debate is open to determine which specific situations are suitable to use one agent or the other.…”

“…Toxicity was mild, only 5.5% of patients complained with mild local burning after topical DMSO application and 27.5% reported an unpleasant breath odor. Although in the ESMO-EONS guidelines for chemotherapy extravasation, it is mentioned that some countries only have the presentation of DMSO 50% [4], it should be clarified that, as mentioned by Conde-Estevez and Mateu-de-Antonio, the available evidence is only for DMSO 99%.…”

Chemotherapy Extravasation Injuries

“…There is some controversy regarding its efficacy, but prospective studies have demonstrated that intermittent (2 to 4 times daily) application for 2 to 14 days can limit anthracycline injury. 12 Granulocytemacrophage colony-stimulating factor and N-acetylcysteine have been used to treat extravasation injury, as well, but there is no good evidence of their efficacy. Local instillation of sodium bicarbonate has been shown to be of little to no benefit and can be toxic to tissues.…”