Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review

Baus, A.; Keilani, Chafik; Bich, C.-S.; Entine, Fabrice; Brachet, M.; Duhamel, P.; Amabile, J.-C.; Malfuson, Jean Valère; Bey, E.

doi:10.1016/j.anplas.2017.11.007

Cited by 17 publications

(11 citation statements)

References 17 publications

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“…1 in [6] where the mildest clinical response shown, a transient depilation, occurs at a dose of 4-6 Gy. In other cases where higher absorbed doses of 10-20 Gy (acute) plus 12-16 Gy (low dose rate irradiation) [14], 20-40 Gy [16] and 43 Gy [6] have been estimated, a moist or wet desquamation, or even skin necrosis was observed.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, we note that in the above-mentioned cases [3,4,8], as well as the present case, where no complications were observed, there was an immediate treatment by local heating, massage, or exercise, as recommended both in the EANM procedure guidelines for treatment with [ 90 Y]Y-Ibritumomab tiuxetan (Zevalin®) [17] and 223 RaCl 2 (Xofigo®) [18] and in the product characteristics of Lutathera® ([ 177 Lu]Lu-DOTATATE) [19]. In most of the reported cases with serious radiation damage [5,14,15,16], no immediate treatment was initiated, while in one recent case with [ 90 Y]Y-Ibritumomab tiuxetan [6], a patient was in need for surgery with removal of necrotic skin and soft tissue even though extravasation was quickly realized and early treatment was attempted by aspiration of the puncture site and massage of the arm. These observations from cases with and without radiation damage indicate that immediate and efficient treatment is decisive for the outcome after extravasation regardless of the size of the molecule.…”

Section: Discussionmentioning

confidence: 99%

“…In a publication from 2017 by van der Pol and colleagues [2], the consequences of radiopharmaceutical extravasation and possible therapeutic interventions were reviewed with mention of 10 cases of extravasation of therapeutic radiopharmaceuticals-in most cases with the isotope 90 Y. More recently cases with 177 Lu [3,4], 223 Ra [5], and an additional case with 90 Y [6] have been reported. In some cases, little or no medical consequences of extravasation are reported, while in other cases severe skin damage can be observed.…”

Section: Introductionmentioning

confidence: 99%

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Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

et al. 2020

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Background: In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation. Case presentation: A case of extravasation of [ 177 Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [ 177 Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects. Conclusions: The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

et al. 2020

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“…Other authors reported generalized cAE and severe allergic reactions with ibritumomab use 147,148,311–313 . Although rare, multiple case reports showed that extravasation of ibritumomab causes dose‐dependent skin necrosis, radiologic burns, transient depilation, wet and dry desquamation, xeroderma, and chronic skin ulceration 172–174 …”

Section: Resultsmentioning

confidence: 99%

The diverse landscape of dermatologic toxicities of non‐immune checkpoint inhibitor monoclonal antibody‐based cancer therapy

et al. 2022

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Background Since their first approval 25 years ago, monoclonal antibodies (mAbs) have become important targeted cancer therapeutics. However, dermatologic toxicities associated with non−immune checkpoint inhibitor (non‐ICI) mAbs may complicate the course of cancer treatment. Data on the incidence and types of these reactions are limited. Methods A comprehensive review was conducted on dermatologic toxicities associated with different classes of non‐ICI mAbs approved for treatment of solid tumors and hematologic malignancies. The review included prospective Phase 1, 2, and 3 clinical trials; retrospective literature reviews; systematic reviews/meta‐analyses; and case series/reports. Results Dermatologic toxicities were associated with several types of non‐ICI mAbs. Inflammatory reactions were the most common dermatologic toxicities, manifesting as maculopapular, urticarial, papulopustular/acneiform, and lichenoid/interface cutaneous adverse events (cAEs) with non‐ICI mAbs. Immunobullous reactions were rare and a subset of non‐ICI mAbs were associated with the development of vitiligo cAEs. Conclusion Dermatologic toxicities of non‐ICI mAbs are diverse and mostly limited to inflammatory reactions. Awareness of the spectrum of the histopathologic patterns of cAE from non‐ICI mAbs therapy is critical in the era of oncodermatology and oncodermatopathology.

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“…Specific guidelines have been published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), which provides practical advice in the case of RPM extravasation (9). Given the physical characteristics of the radiation used (beta or alpha emitters) and depending on the injected volume and the administered activity, RPM extravasation can cause soft tissue damage peripheral to the injection site, ranging from simple skin desquamation (10) to radionecrosis (11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

177Lu-DOTA-0-Tyr3-Octreotate Infusion Modeling for Real-Time Detection and Characterization of Extravasation During PRRT

Christophe

Salvadori

Ritzenthaler

et al. 2021

Preprint

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Purpose. Given the recent and rapid development of peptide receptor radionuclide therapy (PRRT), increasing emphasis should be placed on the early identification and quantification of therapeutic radiopharmaceutical (thRPM) extravasation during intravenous administration. Herein, we provide an analytical model of 177Lu-DOTA0-Tyr3-octreotate (Lutathera®) infusion for real-time detection and characterization of thRPM extravasation. Methods. For 33 Lutathera®-based PRRT procedures using the gravity infusion method, equivalent dose rates (EDRs) were monitored at the patient’s arm. Models of flow dynamics for nonextravasated and extravasated infusions were elaborated and compared to experimental data through an equivalent dose rate (EDR) calibration. Nonextravasated infusion was modeled by assuming constant volume dilution of 177Lu activity concentration in the vial and Poiseuille-like laminar flow through the tubing and patient vein. Extravasated infusions were modeled according to their onset times by considering elliptically shaped extravasation with different aspect ratios. Results. Over the 33 procedures, the peak of the median EDR was reached 14 min after the start of the infusion with a value of 450 uSv/h. On the basis of experimental measurements, 1 mSv/h was considered the empirical threshold for Lutathera® extravasation requiring cessation of the infusion and start again with a new route of injection. According to our model, the concentration of extravascular activity was directly related to the time of extravasation onset and its duration, a finding inherent in the gravity infusion method. This result should be considered when planning therapeutic strategy in the case of RPM extravasation because the local absorbed dose for β-emitters is closely linked to activity concentration. For selected EDR values, charts of extravasated activity, volume, and activity concentration were computed for extravasation characterization. Conclusion. We proposed an analytical model of Lutathera® infusion and extravasation (gravity method) based on EDR monitoring. This approach could be useful for the early detection of thRPM extravasation and for the real-time assessment of activity concentration and volume accumulation in the extravascular medium.

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Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review

Cited by 17 publications

References 17 publications

Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

The diverse landscape of dermatologic toxicities of non‐immune checkpoint inhibitor monoclonal antibody‐based cancer therapy

177Lu-DOTA-0-Tyr3-Octreotate Infusion Modeling for Real-Time Detection and Characterization of Extravasation During PRRT

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