A New Conservative Approach to Extravasation of Anthracyclines with Dimethylsulfoxide and
Dexrazoxane

Annelies M. E. Bos, Winette T. A. van der Graaf and Pax H. B. Willemse
From the Division of Medical Oncology, Department of Internal Medicine, University Hospital Groningen, The Netherlands

Extravasation of anthracyclines during intravenous (IV) administration can result in tissue damage ranging from slightly painful
localized inflammation to widespread necrosis extending to the fascia and periosteum. In the latter situation or if conservative
measures have failed, surgical debridement and reconstructions with skin grafts are indicated (1, 2). Several antidotes have been
proposed to prevent or reduce tissue necrosis and to avoid the need for reconstructive surgery (3). Conservative treatment of
accidental extravasation of anthracyclines usually comprises local cooling and topical dimethylsulfoxide (DMSO) (4). We describe a
new successful conservative approach after extravasation of epirubicin, using ice packs, topical application of DMSO and dexrazoxane as a systemic antidote.

REFERENCES
1. Larson DL. Treatment of tissue extravasation by antitumor agents. Cancer 1982; 49: 1796–9.
2. Loth TS. Minimal surgical debridement for the treatment of chemotherapeutic agent induced skin extravasations. Cancer
Treat Rep 1986; 70: 401–4.
3. Dorr RT. Antidotes to vesicant chemotherapy extravasations. Blood Rev 1990; 4: 41–60.
4. Bertelli G. Prevention and management of extravasation of cytotoxic drugs. Drug Saf 1995; 12: 245–55.

Acta Oncologica Vol. 40, No. 4, pp. 541–542, 2001