Extravasational side effects of cytotoxic drugs: A preventable catastrophe

Abstract

In addition to their therapeutic effects on malignant cells, cytotoxic agents have the potential of causing destruction of healthy, normal cells. Extravasation of the drug can produce extensive necrosis of the skin and subcutaneous tissue. Management of these extravasational effects differs from one centre to another and prevention is usually strongly emphasized. We analyzed our management of 12 patients referred to us over five years with extravasation of cytotoxic drugs and reviewed the literature for different approaches with regard to prophylaxis and management of extravasational effects.Materials and Methods:This study was done in the department of plastic surgery of a medical college. Five years of retrospective data were studied of patients referred to our department with extravasation of cytotoxic drugs.Results:We managed 12 cases referred to our department with extravasation of cytotoxic drugs. Mitomycin C was used in seven cases (58.33%), vincristine in two cases (16.66%), 5-Florouracil in another two cases while doxorubicin was responsible for extravasational side effects in one case (8.33%). The size of necrosis ranged from 3.75 cm2 to 25 cm2 with average size of 9.6 cm2. In terms of the area involved, the dorsum of the hand was involved in five cases (41.66%), the wrist in another five cases (41.66%), and the cubital fossa in the remaining two cases (16.66%). All cases were treated with daily debridement of necrotic tissue, saline dressing, and split skin grafting.Conclusion:Extravasation of cytotoxic drugs further increases the suffering of cancer patients. This catastrophe can only be avoided by vigilance and immediate application of antidotes. Once the local toxicity of the drugs takes effect, morbidity is unavoidable

Hypoxia Promotes Synergy between Mitomycin C and Bortezomib through a Coordinated Process of Bcl-xL Phosphorylation and Mitochondrial Translocation of p53

“…It has been tested in a great number of preclinical and clinical studies and is widely used to treat PC (9). However, mitomycin C alone is not potent enough to generate sustained tumor regression and has been shown cause unexpected side effects (10, 11). Therefore, we should consider combinations of cytotoxic drugs and other agents that have achieved improvement in animal models and patients (12–14), thereby enhancing the likelihood of survival for CPC patients.…”

The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report

“…; Dougherty & Lister ; RCN ) is characterised in the literature as being a ‘dreaded complication of chemotherapy’ or a ‘catastrophe’ (Schrijvers , p. 26; Thakur et al . , p. 145) as the outcome of any ineffectually managed extravasation can be potentially devastating (Ener et al . ; Arroyo et al .…”

Extravasational toxicity of anticancer chemotherapy and its management

“…However, drugs to be given longer than 1 h should be administered only via a central line 15,23,24 . The flexible intracatheter devices should be used, as other rigid devices have a tendency for vessel injury 8,15 . Forearm is the preferred site due to catheter stability and muscle protection for the nerve and tendons in the event of extravasation, which is inevitable in case of access on hand or wrist 8 .…”

“…The flexible intracatheter devices should be used, as other rigid devices have a tendency for vessel injury 8,15 . Forearm is the preferred site due to catheter stability and muscle protection for the nerve and tendons in the event of extravasation, which is inevitable in case of access on hand or wrist 8 . Venous access should be secured in a single attempt and in case of failure, the site should be changed to another proximal vein.…”

“…In India, the oncology department is overloaded with cancer patients; hence, anticancer drugs are being infused in the parent departments by nurses and residents. However, extravasational toxicity is one of the dreaded complications of anticancer drugs, which didnot find a place in the majority of clinical textbooks [1][2][3][4][5][6][7] other than oncology, and hence many of the residents may be unaware of this preventable catastrophe 8 . The incidence of extravasations in adults is 0.1% to 6.5% 9,10 .…”