Reeves David
Department of Pharmaceutical Services, William Beaumont Hospital, 3601 W. Thirteen Mile Rd., Royal Oak, MI 48073, USA.
Ann Pharmacother. 2007 Jul;41(7):1238-42. doi: 10.1345/aph.1H700. Epub 2007 Jun 5.
To review the evidence for the management of anthracycline extravasation and determine the optimal treatment of such injuries.
A search of MEDLINE (1966-February 2007) and International Pharmaceutical Abstracts (1970-February 2007) was performed using the search terms anthracyclines and extravasation.
Extravasation of anthracyclines can have devastating effects. After infiltration of these drugs into the interstitial tissue, damage may range from mild erythema and pain to severe tissue necrosis. Many agents have been studied in the management of these injuries; however, few have demonstrated efficacy and treatment remains controversial. Nonpharmacologic modalities shown to limit extravasation injuries include local tissue cooling and elevation of the affected area. Corticosteroids, sodium bicarbonate, hyaluronidase, hyperbaric oxygen, heparin fractions, alpha-tocopherol, N-acetylcysteine, and granulocyte macrophage-colony stimulating factor have all either been shown to be ineffective or have limited data supporting their use. Topical dimethyl sulfoxide (DMSO) has been shown in prospective studies to limit the course of extravasation injuries. Dexrazoxane has been shown in animal models and case reports to be useful in the management of anthracycline extravasation. Two recent prospective clinical trials examining intravenous dexrazoxane 1000 mg/m2 within 6 hours of extravasation, 1000 mg/m2 24 hours after extravasation, and 500 mg/m2 48 hours after extravasation injuries add to the data supporting the use of this agent in such injuries. Of the 54 patients enrolled, surgery-requiring necrosis was avoided in 98.2%.
The optimal treatment of anthracycline extravasation includes local tissue cooling, elevation of the afflicted extremity, dexrazoxane administration, and possibly topical DMSO. Many other drugs have been investigated; however, due to a lack of data, they cannot be recommended for the management of anthracycline extravasation.
回顾有关蒽环类药物外渗处理的证据，并确定此类损伤的最佳治疗方法。
使用搜索词“蒽环类药物”和“外渗”对MEDLINE（1966年 - 2007年2月）和《国际药学文摘》（1970年 - 2007年2月）进行检索。
蒽环类药物外渗可产生毁灭性影响。这些药物渗入间质组织后，损伤程度可从轻度红斑和疼痛到严重的组织坏死。许多药物已被研究用于处理这些损伤；然而，很少有药物显示出疗效，治疗方法仍存在争议。已证明可限制外渗损伤的非药物方法包括局部组织冷却和抬高受影响区域。皮质类固醇、碳酸氢钠、透明质酸酶、高压氧、肝素片段、α-生育酚、N-乙酰半胱氨酸和粒细胞巨噬细胞集落刺激因子均已显示无效或仅有有限的数据支持其使用。前瞻性研究表明局部使用二甲亚砜（DMSO）可限制外渗损伤的病程。在动物模型和病例报告中已显示右丙亚胺对处理蒽环类药物外渗有用。最近两项前瞻性临床试验研究了在外渗后6小时内静脉注射右丙亚胺1000 mg/m²、外渗后24小时静脉注射1000 mg/m²以及外渗损伤后48小时静脉注射500 mg/m²，这些研究进一步补充了支持该药物用于此类损伤的数据。在纳入的54例患者中，98.2%避免了需要手术治疗的坏死。
蒽环类药物外渗的最佳治疗方法包括局部组织冷却、抬高患肢、给予右丙亚胺，可能还包括局部使用DMSO。许多其他药物已被研究；然而，由于缺乏数据，它们不能被推荐用于处理蒽环类药物外渗。
