Firm Operations Continue Uninterrupted During the Coronavirus. Click for More Information ›

Extravasation Of Chemotherapeutic Agents

The extravasation of intravenously administered chemotherapeutic agents into the subcutaneous tissue of cancer patients undergoing chemotherapy is a known risk of treatment. The potential gravity of injury caused by extravasation is dependent upon the type of drug which extravasates. The most destructive extravasation injuries are those caused by anti-tumor drugs which bind to deoxyribonucleic acid (DNA), such as Doxorubicin, (Adriamycin) which has been a primary part of chemotherapeutic regimes since the late 1960's. Extravasation of chemotherapeutic agents which bind to nucleic acids can lead to a prolonged course of injury. The most clinical experience has been derived from the extravasation of Doxorubicin. Rudolph, R, Larson, D. Etiology and Treatment of Chemotherapeutic Agent Extravasation Injuries: A Review. J. Clin. Oncol, 1987; 5:1116-1126. Doxorubicin causes severe progressive tissue necrosis that may involve muscles and tendons. Since no specific antidote has been developed, the recommended treatment of Doxorubicin extravasation is early excission of all infiltrated tissue. Dahlstrom, KK, Chenoufi, HL, Daujard, S. Fluorescene microscopic demonstration and demarcation of Doxorubicin extravasation. Experimental and Clinical studies. Cancer, 1990 Apr. 15; 65(8): 1722-1726.

It has been postulated that infiltration of Hyaluronidase, which may serve to dilute the extravasated Doxorubicin, will decrease the amount of ulceration caused by the extravasation. Disa JJ, Chang RR, Mucci JJ, Goldberg N.H., Prevention of Adriamycin-induced full-thickness skin loss using hyaluronidase infiltration. Plast. Reconstr. Surg. 1998 Feb., 101(2):370-374. In this regard the injection of saline solution at the site of extravasation of a vesicant (blistering) chemo-therapeutic agent in order to reduce the concentration of the extravasated drug has been reported to have been effective. Scuderini, Onesti MG, Anti-tumor agents: Extravasation, Management and Surgical Treatment. Am. Plast. Surg. 1994 Jan; 32(1):39-44. However, other authors have emphatically stated not to inject saline, sodium bicarbonate or hyaluronidase into the extravasation area as to do so may increase the diffusion of the extravasated agent into surrounding tissue. Hankin FM, Louis DS, Extravasation of Chemotherapeutic Agents. Am. Fam. Phys. 1985 March; 31(3)147-150.

For some time the injection of steroids into the subcutaneous tissue at the site of Doxorubicin extravasation was recommended on the theory that steroids would reduce inflammation. However, it has been demonstrated that inflammatory cells are uncommon in tissue damaged by Doxorubicin extravasation. Rudolph R, Stein RS, Patillo R: Skin Ulcers Due to Adriamycin. Cancer 38:1087-1094, 1976; Larson DL: What is the appropriate treatment of tissue extravasation by anti-tumor agents? Plast Reconstr Surg 75:397-405, 1985. In 1996 the package insert for Adriamycin was changed. Prior thereto, the injection of steroids was recommended in the event of extravasation. In 1996 it was stated that the benefit of local administration of drugs has not been clearly established. Close observation and plastic surgery consultation were recommended. The immediate treatment of DNA-binding chemotherapy extravasation should include elevation of the effected extremity and intermittent cold. There does not seem to be any agent that, injected locally, can alter the final result from extravasation of any binding chemotherapeutic agent. Persistent swelling, erythema and pain are indications for surgical consultation, even if ulceration is not yet apparent. Such consultation is mandatory when blistering and ulceration are first seen. Rudolph and Larson, supra. Snyderman RK, Krasna MJ, Adriamycin extravasation injuries. Plast Reconstr Surg 1986 Apr; 77(4):683-684.

For a discussion of a case involving Failure to properly treat extravasation of doxorubicin (Adriamycin). Click here.

Disclaimer: Please be advised that the results achieved in any given case depend upon the exact facts and circumstances of that case. Gair, Gair, Conason, Rubinowitz, Bloom, Hershenhorn, Steigman & Mackauf cannot guarantee a specific result in any legal matter. Any testimonial or case result listed on this site is based on an actual legal case and represents the results achieved in that particular case, and does not constitute a guarantee, warranty or prediction of the outcome of any other legal matter.

Client Reviews
★★★★★
"Very compassionate, very efficient and top rate! If you want a team of good lawyers that will not only work hard to win your case but knows how to listen and feel for you as a victim of medical malpractice, this firm is your only choice. Anthony Gair, was always there for us all throughout the case albeit the distance from NY to Manila! Words cannot express how thankful we are to him and his team. Thanks a million!" D.F.
★★★★★
"Everyone I communicated with at this firm made me feel like I was part of their family. My needs, feelings, and concerns were carefully considered and given the needed attention. My counselors were available whenever I needed them and became my personal friends. They came highly recommended and lived up to their reputation. I would recommend them to any of my friends without hesitation. This firm gives attorneys a "good name". Clients matter here. They made me feel like I mattered as a person, that I was valued, and not just a possible source of income for the firm. They earned their fees, and you will find that they will also earn your trust." N.W.
★★★★★
I met Diana Carnemolla and Howard S. Hershenhorn during the darkest time of our lives, when my husband was in a coma with very little chances to survive, due to a car accident. The compassion and professionalism that they showed myself and my family during such a difficult time combined with an incredible willingness to get the best results for us have shown us that we had made the absolute best choice. They not only fought extremely hard for what proved to be a very difficult case, but they also emotionally helped us through this incredible ordeal and have been a caring advocate for our family and our case. They got us the best results we could have expected given the circumstances and didn't give up when things got more challenging. We would absolutely recommend their Law Firm to handle the toughest of cases while providing such a great deal of personal support. Diana proved to be personally invested in our case ultimately seeking the best outcome for our family. We cannot thank them enough for what they have done for us. V.P.