Alfaro-Rubio Alberto, Sanmartín Onofre, Requena Celia, Llombart Beatriz, Botella-Estrada Rafael, Nagore Eduardo, Serra-Guillén Carlos, Hueso Luis, Guillén Carlos
Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
Actas Dermosifiliogr. 2006 Apr;97(3):169-76. doi: 10.1016/s0001-7310(06)73375-0.
The extravasation of cytostatic agents is a known, serious situation that can easily occur and cause chronic, irreversible damage. The incidence of extravasation ranges from 0.1 %-6.5 %, according to different studies. Many cases of extravasation can be prevented by systematizing the administration techniques for cytostatic agents. We present the clinical and histological characteristics of a series of patients with extravasation lesions. Included in the study were all patients treated with chemotherapy who developed localized lesions in the area of the cytostatic injection after extravasation was detected during administration. The patients were studied and followed up for a three-year period, from January 2000 to December 2003, inclusive. We found nine cases of extravasation among the 2,186 patients who were treated with chemotherapy, which represents an incidence of 0.41 %, and 3.4 % of all chemotherapy-induced skin lesions. The cytostatic agent most often involved was vinorelbine, and the most frequent location was the antecubital fossa. The intensity of the lesions made it necessary to delay the next cycle of treatment in 55 % of the cases. The histological findings varied depending on when the biopsy was done, showing panniculitis with low cellularity together with epidermal lesions attributable to direct cytotoxicity. The best treatment for extravasation is prevention, but when it has already occurred, measures vary depending on the cytostatic drug extravasated and the intensity of the lesions. Conservative measures are advisable before surgery.
细胞毒性药物外渗是一种已知的严重情况，很容易发生并导致慢性、不可逆的损伤。根据不同研究，外渗的发生率在0.1%-6.5%之间。通过规范细胞毒性药物的给药技术，许多外渗情况是可以预防的。我们展示了一系列外渗性损伤患者的临床和组织学特征。该研究纳入了所有接受化疗的患者，这些患者在给药过程中检测到外渗后，在细胞毒性药物注射部位出现局部损伤。对这些患者进行了为期三年的研究和随访，从2000年1月至2003年12月，包括这期间。我们在2186例接受化疗的患者中发现了9例外渗，发生率为0.41%，占所有化疗引起的皮肤损伤的3.4%。最常涉及的细胞毒性药物是长春瑞滨，最常见的部位是肘前窝。55%的病例因损伤严重程度而有必要推迟下一个治疗周期。组织学结果因活检时间不同而有所差异，表现为细胞数量少的脂膜炎以及归因于直接细胞毒性的表皮损伤。外渗的最佳治疗方法是预防，但当外渗已经发生时，治疗措施因外渗的细胞毒性药物和损伤强度而异。在手术前，保守措施是可取的。
