Local toxicity of antracycline extravasation.

To cite: Revannasiddaiah S, Pandey KC, Pant NK, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-009711 DESCRIPTION A woman diagnosed with breast cancer was previously treated with surgery and chemotherapy before being referred to us for radiotherapy. During planning radiotherapy, an incidental observation was made of a conspicuous discolouration over the dorsal aspect of the left hand (figure 1). On requesting further information, the patient recalled having experienced an incident where “a red coloured drug had leaked out of the vein during chemotherapy.” With that information, it could be concurred that the patient had suffered an extravasation of an anthracycline agent such as doxorubicin or epirubicin which is an important part of chemotherapy for breast cancer. Anthracycline extravasation is a serious event which is accompanied by a risk of irreversible tissue necrosis, the risk of which is estimated to be 25–50% if untreated. Urgent measures after extravasaion include the immediate cessation of the intravenous line, estimation of an approximate amount of extravasated drug, application of cold compresses and hospitalisation of the patient for close observation. The use of local measures such as topical dimethylsulfoxide, intralesional corticosteroid and hyaluronidase injections have not been supported by convincing clinical evidence. Recent evidence points towards the efficacy of dexrazoxane, which when used systemically acts as an antidote to the local effects of extravasated anthracyclines. 3 The patient in the current discussion informed us as having been treated with the use of cold compresses and observation in the hospital for a week.