CLINICAL-RESULTS AFTER DOXORUBICIN EXTRAVASATION TREATED WITH EXCISION GUIDED BY FLUORESCENCE MICROSCOPY

Doxorubicin (DR) and epirubicin (ER) produce progressive tissue necros is when extravasation occurs. Early detection and excision of all affe cted tissue is important. The clinical experience with fluorescence mi croscopic guided detection and excision in 24 patients is evaluated. 9 patients with fluorescence negative specimens were kept under observa tion without excision. None developed necrosis. Wide excision was perf ormed on 15 patients with fluorescence positive specimens. Sequelae, d efined as impaired function of the affected limb at the last control e xamination in the out-patient clinic, were observed in 8 patients. 4 o f 5 patients with extravasation in the hand and 2 of 3 with extravasat ion in the cubital fossa were among these. Delay, defined as time from injury to surgery, was a median of 7 h, range from 3 h to 69 days. Pa tients developing sequelae had a median delay of roughly 4-fold that o f patients without these complications. Patients with extravasation in the cubital fossa were hospitalised for the longest period: 30 days, range 24-45 days, vs. 12 days, range 7-80 days, for those with extrava sation at other sites (P < 0.03). Our conclusions are: (1) fluorescenc e microscopic analysis is a reliable method for the detection and deli neation of extravasation of DR or ER. (2) Do not use the cubital fossa or hand for the infusion of these cytostatics. (3) Act promptly if ex travasation is suspected-delay leads to sequelae.