title: Intrapleural extravasation of epirubicin, 5-fluouracil, and cyclophosphamide, treated with dexrazoxane.
abstract: 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.
authors.affiliation: Medical Centre Haaglanden, Lijnbaan 32, postbus 432, 2501CK, The Hague, The Netherlands. j.uges@mchaaglanden.nl
authors.forename: Joris W F
authors.initials: JW
authors.lastname: Uges
authors.forename: Albert M
authors.initials: AM
authors.lastname: Vollaard
authors.forename: Erik B
authors.initials: EB
authors.lastname: Wilms
authors.forename: Rolf E
authors.initials: RE
authors.lastname: Brouwer
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D035422:Pleural Cavity; D010996:Pleural Effusion / Q000188:drug therapy* / Q000473:pathology; D011929:Razoxane / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D011929:Razoxane; D003520:Cyclophosphamide; D005472:Fluorouracil