Anthracyclines are the major anti-neoplastic drugs used in gynecological cancer chemotherapy. The overall incidence of extravasation due to vesicant anti-neoplastic agents such as anthracyclines is low. This type of extravasation may cause severe tissue damage. A 58-year-old woman with a prediagnosis of peritonitis carcinomatosa of unknown origin was referred to our center. After the initial work-up, our multidisciplinary gynecologic oncology council decided to perform a treatment strategy consisting of neoadjuvant chemotherapy and interval debulking surgery. Initially she received 3 cycles of Cyclophosphamide (600 mg/m2) and Carboplatin (6 AUC) combination. Because of obtaining suboptimal response to the initial treatment, the chemotherapy regimen was replaced by Cisplatin (75mg/m2) and Doxorubicin (25 mg/m2). During the 2nd course of Doxorubicin, an extravasation occured at the catheter site in the back of the patient's left wrist. In the acute stage of this extravasation, local cold compression therapy was performed and affected extremity was elevated. Due to unavailability of specific antidotes, we could not apply any topical drug such as dimethyl sulfoxide (DMSO) and dextrazoxane. Three weeks later, necrosis and ulceration developed in the area of injury. After a wide debridement of necrotic tissues, full-thickness skin graft was applied to close the wound properly. The wound healed completely, but about one year later the patient died from the progression of the cancer. Oncology specialists and nurses should be aware of vesicant extravasation and keep specific antidotes available for certain vesicant chemotherapeutic agents. Also it should be kept in mind that aggressive surgical interventions and skin grafts could be required for the appropriate treatment of this condition.
Vesicant extravasation due to doxorubicin administration in a patient with primary unknown peritonitis carcinomatosa
Journal of Cases in Obstetrics & Gynecology
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