This one mentions chest wall, it also mentions not using the
same chemo " to avoid any recall reaction" J
asco.org1,1003, 12 002636 00 18 0023Open ↗
00_19-00100171,00.asp Meeting: 2003 ASCO Annual Meeting
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Category: Developmental Therapeutics - Cytotoxic
Chemotherapy SubCategory: Pharmacology/Pharmacokinetics
Dexrazoxane is an effective immediate therapy for
doxorubicine extravasation
Abstract No: 580 Citation: Proc Am Soc Clin Oncol 22: page
145, 2003 (abstr 580) Author(s): N. S. El-Saghir, Y. Abou
Mrad, J. Abbas, A. Mufarrij, A. Shamseddine, Z. Salem;
American Univ of Beirut, Beirut, Lebanon Abstract:
Doxorubicin (Adriamycin) extravasation is an oncologist's
nightmare. Dexrazoxane prevention of adriamycin
cardiotoxicity prompts its use in extravasation.
We report a 38 y-o-f with breast cancer who had chest wall
extravasation of about 50 mg of adriamycin. She had pain and
swelling around port-a-cath entrance. Nurse stopped
infusion. Needle was noted misplaced. Area was red, painful,
swollen, and hard. We feared massive tissue necrosis of
chest wall. Within one hour we infused 1500 mg of
Dexrazoxane. There were immediate relief of pain and
decreased tissue tension. We repeated 1500 mg at 5 hours and
750 the next day.
We also applied DMSO on skin every 6 hours for 3 doses and
stopped it because it induced skin redness and tissue
swelling. We did not apply cold compresses and avoided
vasoconstriction to allow Dexrazoxane to diffuse freely into
the entire injured area.
At 48 hours, the patient was doing well. She had no
significant side effects.
We omitted further adriamycin to avoid any recall reaction.
We proceeded with taxotere after 3 weeks and completed BCIRG
005 adjuvant protocol. No further changes occurred at
extravasation site. She only has skin pigmentation and
occasional pain at extravasation site. Port-a-cath was
intact by contrast study. At 4 months from incident, the
patient had a small 2 mm dehiscence of the surgical scar of
chamber entry with a whitish necrotic minor discharge and no
further progression after 5 months.
In conclusion, Dexrazoxane prevented severe tissue necrosis
due to massive accidental extravasation of adriamycin into
the chest wall.
Our report, along with Langer's experiments in rats (Ann
Oncol 2001) and correspondence (JCO 2000) regarding 2
patients with adriamycin and epirubucin, and the case report
of Bos (Acta Oncol 2001) for epirubicin, should make
anthracycline extravasation a major indication for its use.
Dose of 1000 mg/m2 should be given as soon as possible and
repeated at least once the next day. Every oncologist,
resident and nurse should be made aware of
it. Dexrazoxane (Zinecard, Cardioxane) should be always
available on all oncology units.
extravasation.org.ukTax1.htmOpen ↗ Taxol-Induced
Cellulitis after Extravasation: A Rarely Reported Event
Am J Oncol (CCT) 20(5):540,1997
Letter To the Editor:
The antineoplastic agent paclitaxel (Taxol®, Mead Johnson,
Evansville, IN, U.S.A.) is a complex plant product (a
ditrepene) that - with its unique mechanism (induction of
tubulin polymerization)- has demonstrated clinical antitumor
activity in advanced and refractory ovarian, breast, and
lung cancers.1 The toxicity mostly encountered with its use
includes myelosuppression, hypersensitivity reaction,
cardiotoxicity, and neuropathy.2 Rarely, local venous
effects - including erythema, tenderness, and discomfort
along the course of an injected vein - and phlebitis have
been described, particularly when large volumes (>50 mL) are
infused.2 Skin and soft-tissue injuries caused by Taxol®
extravasation have been exhibited sporadically2-4 and are
characterized by pain, erythema, skin ulceration, and
cellulitis, followed by sclerosis and hyperpigmentation.3-5
We describe cellulitis caused by extravasation of
intravenously administered Taxol® in one of our patients.
A 68-year-old woman received a 3-hour infusion of 180 mg
Taxol® (130 mg/m2) as second-line chemotherapy for her
metastatic breast cancer. Taxol® was administered through an
implanted PORT-A-CATH (PAC, MID, Ltd., Tel-Aviv, Israel) on
the right chest wall. Due to mechanical fault, the
dislocated PAC caused extravasation of approximately 200 mg
Taxol. Cellulitis with sharply demarcated erythema, local
heat, and blisters developed. On catheter removal and
institution of antibiotics, the cellulitis disappeared.
Soft-tissue injury, secondary to inadvertent extravasation
of chemotherapeutic agents (particularly anthracyclines),
nitrogen mustard, mitomycin C, vincristine, vinblastine, and
vindesine still constitutes a serious management problem.5
Taxol® is also a vesicant agent that has been described as
causing symptomatic and extended soft-tissue injury,
histologically resembling coagulative necrosis with minimal
inflammatory changes.1,5 Severe irradiation recall
dermatitis and even necrosis at sites of prior Taxol®
extravasation have also been exhibited.3 Proposed mechanisms
for Taxol-induced skin and subcutaneous injury are variable
and can be related to the Cremophor® (Mead Johnson,
Evansville, IN, U.S.A.) vehicle in which Taxol® is
formulated. Because of its high molecular weight, bulky
structure, and avidity for tissue protein, Taxol® exits
tissues slowly (partly because of its microtubule
accumulation) and markedly increases local tissue exposure -
hence, local injury.1,5,6 Treatment options are not well
documented and protocols focus mainly on minimizing the
amount of drug extravasated by aspiration before removing
the intravenous catheter, close observation, and the
application of warm compresses.
In conclusion, physicians involved in the administration of
Taxol® should be aware of its severe skin and subcutaneous
side-effects. Patients receiving Taxol® should be monitored
for extravasation.
Moshe Efraim Stein, M.D. Kerem Drumea, M.D. Rasem Abu-Rasmi,
M.D. Nissim Haim, M.D Northern Israel Oncology Center,Rambam
Medical Center Faculty of Medicine,Technion-Israel Institute
of Technology Haifa, Israel. Acknowledgement: The authors
thank Mrs. M. Perlmutter for her assistance in the
preparation of this paper.
REFERENCES - read them
