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 this group of drugs. We describe a 54-year-old woman with history of stage IIIa breast cancer, receiving adjuvant chemotherapy consisting of doxorubicin and cyclophosphamide. The chemotherapy was administered through a Poweport^® device, the position of which was confirmed with fluoroscopy and function confirmed by flushing the line. Urgent intervention was required as patient was symptomatic and experienced severe right-sided pleuritic chest pain. Radiology also confirmed the extravasation 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 be considered following intra-pleural extravasation because of its potential efficacy and reasonable tolerability. However, the best approach to extravasation injury is prevention by systematic implementation of careful, standardized, evidence-based administration techniques.

Figure 1:

Position of the line confirmed with fluoroscopy and function confirmed by flushing the line

Figure 2:

Fluoroscopy contrast study showing contrast medium flowed over the surface of the lung in the pleural cavity. The Port-A-Cath tubing tip is now in the pleural cavity.

Figure 3:

Chest drain inserted for continuous irrigation post-procedure

Figure 4:

Chest X-ray just showing small right pleural effusion without any other abnormalities. Taken at 1 month after the incident.

Figure 5:

Repeat chest X-ray taken 10 months after extravasation again showing right pleural effusion without any other abnormalities