Intrathoracic Extravasation of Antineoplastic Agents

Bozkurt, Kürşat A.; Uzel, Burak; Akman, Canan; Özgüroǧlu, Mustafa; Mandel, Nil Molınas

doi:10.1097/01.coc.0000017088.74592.96

Cited by 10 publications

(7 citation statements)

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“…This is also reflected by the dramatic rise in the number of malpractice claims related to extravasation from implanted intravenous catheters. 4 In their review of intrathoracic extravasation of chemotherapeutic agents from implanted ports, Bozkurt et al 7 describe the extravasation of epirubicin (two cases), 5-FU (three cases) and a combination of these two agents (one case). Thoracic pain and fever were the prominent symptoms in these patients.…”

Section: Discussionmentioning

confidence: 97%

Intrapleural extravasation of epirubicin, 5-fluouracil, and cyclophosphamide, treated with dexrazoxane

et al. 2006

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The extravasation of DNA-binding vesicant drugs, such as epirubicin, is a feared complication of chemotherapy and can lead to extensive damage at injury sites. We describe a 56-year-old woman with breast cancer who received adjuvant chemotherapy after a breast-preserving surgical procedure. Due to catheter tip misplacement, epirubicin, 5-fluouracil, and cyclophosphamide were administered intrapleurally. To minimize long-term sequelae, flushing of the cavities and systemic administration of steroids were performed. Besides this treatment, empirically, 3-day therapy with dexrazoxane was added to prevent tissue damage and the risk of cardiac damage. Because of the potential benefits of dexrazoxane and its relatively mild side effects, its use should be considered in cases of the intrapleural extravasation of anthracyclines. We do emphasis the need for stringent surgical and oncological nursing procedures when using central venous access catheters in oncology.

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Section: Discussionmentioning

confidence: 97%

Intrapleural extravasation of epirubicin, 5-fluouracil, and cyclophosphamide, treated with dexrazoxane

et al. 2006

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“…In 1991 and 1992 two cases involving 5-fluorouracil were reported, in which the agent caused pericardial effusion and cardiac arrhythmia in one case, and necrotising chemical pneumonitis in the other [6,7]. During the last decade four cases of mediastinitis, caused by vinblastine [8], epirubicine-5-fluorouracil [9], daunorubicine [10] and epirubicine [11] have been reported. Furthermore, a breast fibrosis case due to paclitaxel extravasation when the catheter migrated through the subcutaneous tunnel to that location [12] and a case of treosulphan extravasation to the bronchial tree after superior vena cava perforation [13] were reported.…”

Section: Discussionmentioning

confidence: 98%

“…This practice may involve infectious, thrombotic and mechanical complications such as catheter fragmentation, migration of the tip, obstruction due to fibrosis and fragment embolisation [3,4]. Extravasation of chemotherapy agents into the thorax is a very rare complication; only ten cases are reported in the literature, including this one [5][6][7][8][9][10][11][12][13]. All cases were caused by vesicant agents.…”

Section: Discussionmentioning

confidence: 99%

“…Many antidotes (corticoids, hyaluronidase, dimethylsulphoxide, sodium thiosulphate) are used for peripheral extravasations, although data on their activity in mediastinal extravasation cases are scarce. Three patients, in addition to our patient, were treated with systemic corticoids [9][10][11]. All of the patients survived the extravasation and developed minimal sequelae.…”

Section: Discussionmentioning

confidence: 99%

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Mediastinal extravasation of doxorubicin

et al. 2008

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A 48-year-old woman with a diagnosis of breast carcinoma was treated with adjuvant chemotherapy through a central venous catheter with subcutaneous reservoir (Port-A-Cath). While doxorubicin was administered, the patient presented thoracic pain and breathing distress due to superior vena cava perforation by the central catheter and subsequent extravasation of the drug into the mediastinum. The patient recovered without sequelae with conservative therapy. Cytostatic extravasation via central catheter is an uncommon complication in clinical practice. In this paper we present the first doxorubicin extravasation through a central catheter in adults and review the only ten cases found in the literature.

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“…The symptoms of extravasation from a CVC may be very different from the symptoms seen at peripheral vein extravasations and may have a delayed onset. For example, chest wall infiltration may present as shoulder pain while mediastinal leakage may present as substernal chest pain [3]. Even with the best surgical techniques and devices, accidental extravasation still occurs.…”

Section: Centrally Inserted Vein Cathetersmentioning

confidence: 99%