Management of anthracycline extravasation into the pleural space

Abstract

Anthracycline extravasation is a feared complication of intravenous (i.v.) chemotherapy due to the tissue toxicity of thisgroup of drugs. We describe a 54-year-old woman with history of stage IIIa breast cancer, receiving adjuvant chemotherapyconsisting of doxorubicin and cyclophosphamide. The chemotherapy was administered through a Poweport® device, theposition of which was confirmed with fluoroscopy and function confirmed by flushing the line. Urgent intervention wasrequired as patient was symptomatic and experienced severe right-sided pleuritic chest pain. Radiology also confirmed theextravasation of doxorubicin into the pleural space. Surgical washout of the pleural space and 3 days therapy with i.v.dexrazoxane were carried out to prevent tissue damage and long-term sequelae. Use of dexrazoxane should always beconsidered following intra-pleural extravasation because of its potential efficacy and reasonable tolerability. However, thebest approach to extravasation injury is prevention by systematic implementation of careful, standardized, evidence-basedadministration techniques.