Video‐assisted thoracoscopy in the management of intrapleural extravasation of cytotoxic chemotherapy

Abstract

The extravasation of cytotoxic agents into subcutaneous tissue is a serious complication of chemotherapy. Unfortunately, if such extravasation occurs into the pleural space, limited data is available to guide appropriate management. We present the first report in the literature of video‐assisted thoracoscopy combined with a topoisomerase II inhibitor and iron chelator, dexrazoxane, in the successful management of this complication.

Delayed presentation of doxorubicin extravasation into pleural space: Case report and review of literature

“…Intrathoracic extravasation has been reported even with appropriate port positioning and function. 7,8 When efflux of the drug from CVAD occurs, the solution may accumulate in the mediastinum, pleura or in a subcutaneous area of the chest or neck. Implementation of a preventive protocol can help minimize the risk of anthracycline extravasation.…”

“…14 Fluoroscopy with dye injection and contrast-enhanced CT scan are the preferred imaging modalities for diagnosing extravasation. 2,8 The most common imaging findings include observation of dye extravasation, catheter misplacement, pleural and pericardial effusions (Table 2). 2,[5][6][7] Immediate surgical consultation to drain the remaining solution and irrigate the cavity is necessary.…”

“…2,[5][6][7] Immediate surgical consultation to drain the remaining solution and irrigate the cavity is necessary. 3,8 Percutaneous drainage and VATS with normal saline irrigation have been used for this purpose (Table 2). 2,6,8 There is no clear protocol for medical management of intrathoracic anthracycline extravasation.…”

“…Over the course of the next three days the patient received intravenous dexrazoxane at a dose of 1000 mg/ m 2 on the first day and 500 mg/m 2 on the second and third postoperative day based on the data from prior reported cases. 2,8 Despite administration of tbofilgrastim on post-chemotherapy day 2 and 3, the patient became neutropenic on post-chemotherapy day 7 (hospital day 6) and required administration of additional dose of tbo-filgrastim. Her chest pain diminished over the course of her hospital stay and she was discharged on hospital day 6.…”

“…In total, seven cases of intrapleural and mediastinal anthracycline extravasation were identified. 2,[5][6][7][8] Most publications were case reports describing symptoms, the timing and type of anthracycline, amount of chemotherapeutic drug administered as well as the immediate management. The details and characteristics of each case report can be found in Table 1.…”