Abstract
BackgroundExtravasation of cytotoxic drugs is a serious complication of systemic cancer treatment. Still, a reliable method for early assessment of tissue damage and outcome prediction is missing. Here, we demonstrate that the evaluation of blood flow by indocyanine green (ICG) angiography in the extravasation area predicts for the need of surgical intervention.MethodsTwenty-nine patients were evaluated by ICG angiography after extravasation of vesicant or highly irritant cytotoxic drugs administered by peripheral i.v. infusion. Tissue perfusion as assessed by this standardized method was correlated with clinical outcome.ResultsThe perfusion index at the site of extravasation differed significantly between patients with reversible tissue damage and thus healing under conservative management (N = 22) versus those who needed surgical intervention due to the development of necrosis (N = 7; P = 0.0001). Furthermore, in patients benefiting from conservative management, the perfusion index was significantly higher in the central extravasation area denoting hyperemia, when compared with the peripheral area (P = 0.0001).ConclusionsIn this patient cohort, ICG angiography as indicator of local perfusion within the extravasation area was of prognostic value for tissue damage. ICG angiography could thus be used for the early identification of patients at risk for irreversible tissue damage after extravasation of cytotoxic drugs.
Highlights
Extravasation as a complication of chemotherapy administration is defined as the unintended instillation or leakage of cytotoxic agents into the perivascular space or subcutaneous tissue
Inclusion criteria for the evaluation by indocyanine green (ICG) angiography were: 1. Patients with a substantial amount of extravasated compound, where the possibility of necrosis was highly suspected; 2
The extravasated compounds were mostly anthracyclines; other cases were caused by extravasations with vinorelbine (N = 5), platinum compounds (N = 3), trabectedin (N = 2), docetaxel (N = 1), and one not specified case
Summary
Extravasation as a complication of chemotherapy administration is defined as the unintended instillation or leakage of cytotoxic agents into the perivascular space or subcutaneous tissue. The degree of local damage depends upon the toxic potential of the extravasated compound and the amount of drug delivered to the perivascular tissue [3]. Methods to objectively document the extent of tissue damage are based on photographic documentation alone. This technique is limited insofar, as sequelae including demarcation of skin, ulceration and necrosis may present weeks after the extravasation event. Novel methods for the reliable identification of the extent of local tissue damage as well as early predictors of outcome are urgently warranted. We demonstrate that the evaluation of blood flow by indocyanine green (ICG) angiography in the extravasation area predicts for the need of surgical intervention
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