Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study.
OBJECTIVE
To evaluate the activity and tolerability of dimethylsulfoxide (DMSO) in the prevention of soft tissue toxicity after extravasation of cytotoxic drugs.


METHODS
From June 1991 to December 1994, all patients who had an extravasation during intravenous (IV) infusion of cytotoxic drugs in our institution were considered for an open, prospective study of preventive treatment with 99% DMSO, applied topically on the extravasation site every 8 hours for 7 days. Intermittent local cooling (for 1 hour three times daily) on the first 3 days was also used.


RESULTS
One hundred forty-four patients with extravasations of doxorubicin (n = 11), epirubicin (n = 46), mitomycin (n = 5), mitoxantrone (n = 13), cisplatin (n = 44), carboplatin (n = 6), ifosfamide (n = 14), and fluorouracil (n = 5) entered the study; 127 were assessable. Only one patient suffered an ulceration. The treatment was well tolerated, with mild local burning and a characteristic breath odor being the only side effects of DMSO application, even in cases in which treatment continued for up to 6 weeks to obtain remission of the symptoms of extravasation.


CONCLUSIONS
Topical DMSO is an effective and safe antidote that may be used with local cooling after extravasations of vesicant drugs other than those drugs for which standard interventions are defined.
Bertelli
G
G
Department of Medical Oncology, National Institute for Cancer Research, Genova, Italy.
Gozza
A
A
Forno
G B
GB
Vidili
M G
MG
Silvestro
S
S
Venturini
M
M
Del Mastro
L
L
Garrone
O
O
Rosso
R
R
Dini
D
D
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003238:Connective Tissue / Q000187:drug effects* / Q000473:pathology; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage / Q000627:therapeutic use*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000188:drug therapy* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011446:Prospective Studies; D012883:Skin Ulcer / Q000209:etiology / Q000517:prevention & control*
D000970:Antineoplastic Agents; D004121:Dimethyl Sulfoxide