Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: A systematic review of the literature and meta-analysis

Villarini, Milena; Gianfredi, Vincenza; Levorato, Sara; Vannini, Samuele; Salvatori, Tania; Moretti, Massimo

doi:10.1016/j.mrrev.2016.05.001

Cited by 57 publications

(35 citation statements)

References 79 publications

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“…The health risks of occupational exposure to cytotoxic drugs have been documented. A recent meta-analysis showed a 67 % higher frequency of micronuclei in peripheral lymphocytes (a marker of genome toxicity) in exposed health care workers compared to controls [18].…”

Section: Discussionmentioning

confidence: 99%

Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Willaert

Paul

Ceelen

2017

Pleura and Peritoneum

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Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel method to treat extensive, small volume peritoneal metastases. The clinical use of chemotherapy containing aerosols represents a potential occupational health hazard. We report the results of toxicological analysis during the first two clinical PIPAC procedures performed at Ghent University Hospital. Methods: After extensive preparation and in vitro testing, two patients were treated with PIPAC: the first using doxorubicin (2.86 mg in 51.43 mL) and cisplatin (14.28 mg in 164.3 mL), the second using oxaliplatin (182.10 mg in 186.42 mL). A standardized safety checklist was developed and used. Aerosol delivery was combined with electrostatic precipitation (ePIPAC). The following samples were obtained at several time points and locations: environmental air, floor surface wipes, surgeon's gloves, surgeon's hand wipes, circuit filters, and fluid from the water seal collection chamber container placed along the closed aerosol waste evacuating line. Platinum concentration was measured in these samples using voltammetry. Sample collection and analysis were performed by an independent external laboratory. Results: Platinum was not detected on the four floor locations after both procedures (detection limit 0.02 ng/ cm 2 ). Similarly, no platinum was detected in environmen-

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Section: Discussionmentioning

confidence: 99%

Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Willaert

Paul

Ceelen

2017

Pleura and Peritoneum

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“…A validated tool comprising nine items assessing several methodological characteristics of primary studies (i.e., number of exposed and controls, matching for multiple risk factors, and number of cells scored per subject) was used for evaluation. For each item, the score could range from 1 to 3, while the total score could range from 9 to 27 points [7].…”

Section: Quality Evaluationmentioning

confidence: 99%

“…However, the risk cannot be tolerated, especially if resulting from occupational exposure. To date, several studies have shown the potential association between occupational exposure to ANDs and side effects on health professionals, both considering genotoxic [6,7] and non-genotoxic effects (i.e., teratogenicity, infertility) [8][9][10]. Genotoxic effects have been mainly evaluated through molecular epidemiology studies, in which biomarkers have been used to assess the effect of exposure to ANDs [11].…”

Section: Introductionmentioning

confidence: 99%

Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis

Gianfredi

Nucci

Fatigoni

et al. 2020

IJERPH

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Background: Antineoplastic drugs (ANDs) are a broad group of chemicals showing, at the same time, carcinogenic effects. The potential, albeit true, risk of side effects cannot be accepted, especially if resulting from occupational exposure. The aim of this study was to evaluate the association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/Medline, Web of Science, and Scopus were used to perform the literature search. The databases were examined in July 2019. Sub-group, moderator, and cumulative analyses were conducted. The trim and fill method was used in the case of potential publication bias. Results: Twenty studies were included in the qualitative analysis, and 19 in quantitative evaluation. The pooled effect size was 1.27 [(95% confidence interval (CI) = 0.66–1.88), p = 0.000] based on 1569 subjects. The moderator analysis by duration of exposure showed a positive association between duration of exposure and primary DNA damage. Conclusions: This systematic review clearly shows a significant association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Considering these results, health professionals should be warned against this potential occupational risk.

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“…A meta-analysis of 14 studies, performed in 1966-2004 in the United States and Europe, described an association between exposure to antineoplastic drugs and adverse reproductive effects on female healthcare workers [6]. Positive results of cytogenetic studies in chromosomal aberrations analysis (peripheral lymphocytes), sister chromatid exchanges observations, micronucleus tests, comet assay and gene mutations assay were described at medical personnel, especially among nurses exposed to different cytostatics [7,8].…”

Section: Introductionmentioning

confidence: 99%

Analytical strategies for assessing occupational exposure to antineoplastic drugs in healthcare workplaces

Dugheri¹,

Bonari²,

Pompilio³

et al. 2018

Med Pr

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Background: Cytotoxic antineoplastic drugs (ADs), widely used in treating cancer, are considered hazardous in the workplace and thus require safe handling practices. An analytical protocol for environmental and biological AD monitoring in the healthcare environment has been developed, since Europe lacks clear guidelines and regulations for cytostatic preparation and handling. Material and Methods: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used for measuring contemporaneously 20 multi-class cytostatic compounds and urinary α-fluoro-β-alanine, whereas platinum was detected by inductively coupled plasma mass spectrometry (ICP-MS). Sampling procedures and analytical conditions were optimized and the assays were validated. Environmental AD monitoring data, collected in 2009-2017, for a total of 3749 wipe tests and 57 720 determinations, was evaluated. Results: The proportion of positive samples gradually decreased from 11.7% in 2010 to 1% in 2017, however, 2266 determinations were positive. No urine sample had detectable concentrations of any of the 4 drugs considered (0/398 samples). Conclusions: These improvements are so large that the key role played by the new, more stringent rules for preparing and administering ADs is evident. Hence, the analytical method involving multi-element determinations allows for a more thorough and complete investigation into the AD contamination of work environments.

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Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: A systematic review of the literature and meta-analysis

Cited by 57 publications

References 79 publications

Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis

Analytical strategies for assessing occupational exposure to antineoplastic drugs in healthcare workplaces

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