Zatkóné Puskás Gabriella
Fovárosi Onkormányzat Uzsoki utcai Kórháza, Onkoradiológiai Központ, Kemoterápiás Ambulancia, Budapest.
Magy Onkol. 2008 Mar;52(1):75-80. doi: 10.1556/MOnkol.52.2008.1.11.
The treatment of cancer may be associated with various chemotherapy-induced mucocutaneous reactions. One of the mucocutaneous adverse effects of antineoplastic drugs is the toxic local tissue reaction, the extravasation, which occurs in less than 1-2% of cytotoxic infusions. The standard management of vesicant extravasation includes: discontinuing all local infusions, aspiration of any residual drug, elevating the involved limb, local cooling or warm compresses, local anesthesia, antidotes (sodium thiosulfate for alkylating agents, dimethylsulfoxide (DMSO) for anthracyclines and mitomycin, and hyaluronidase for the vinca alkaloids), and finally surgical debridement with plastic surgery reconstruction. Because the anthracyclines are topoisomerase II poisons that are antagonized by topoisomerase II catalytic inhibitors such as dexrazoxane, it seems to be the treatment of choice immediately after extravasation of doxorubicin, epirubicin, daunorubicin, etc. One systemic dose of dexrazoxane after the accident may significantly reduce the toxic tissue lesions. Repeated intralesional injections of GM-CSF may accelerate the wound healing without the need of skin grafts.
癌症治疗可能与多种化疗引起的皮肤黏膜反应相关。抗肿瘤药物的皮肤黏膜不良反应之一是毒性局部组织反应，即外渗，其发生率在细胞毒性输注中不到1%-2%。发泡剂外渗的标准处理措施包括：停止所有局部输注，抽吸任何残留药物，抬高受累肢体，局部冷敷或热敷，局部麻醉，使用解毒剂（烷化剂用硫代硫酸钠，蒽环类药物和丝裂霉素用二甲基亚砜（DMSO），长春花生物碱用透明质酸酶），最后进行手术清创并进行整形手术重建。由于蒽环类药物是拓扑异构酶II毒药，可被拓扑异构酶II催化抑制剂如右丙亚胺拮抗，因此在多柔比星、表柔比星、柔红霉素等外渗后，它似乎是首选治疗方法。事故发生后一剂全身剂量的右丙亚胺可能会显著减少毒性组织损伤。重复病灶内注射粒细胞巨噬细胞集落刺激因子（GM-CSF）可能会加速伤口愈合，而无需进行皮肤移植。
