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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2016; 7(1): 87-97
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.87
Overview, prevention and management of chemotherapy extravasation
Firas Y Kreidieh, Hiba A Moukadem, Nagi S El Saghir
Firas Y Kreidieh, Hiba A Moukadem, Nagi S El Saghir, Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 1107 2020, Beirut, Lebanon
Nagi S El Saghir, Breast Center of Excellence, NK Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh 1107 2020, Beirut, Lebanon
Author contributions: Kreidieh FY, Moukadem HA and El Saghir NS contributed to idea and design, literature search, writing of manuscript, approval of final manuscript.
Conflict-of-interest statement: Authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nagi S El Saghir, MD, FACP, Professor of Clinical Medicine, Director (Breast Center of Excellence, NK Basile Cancer Institute), Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon. nagi.saghir@aub.edu.lb
Telephone: +961-1-350000-7489 Fax: +961-1-351706
Received: July 24, 2015
Peer-review started: July 27, 2015
First decision: September 22, 2015
Revised: October 18, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: February 10, 2016
Processing time: 189 Days and 18.9 Hours
Abstract

Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, prevention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.

Keywords: Chemotherapy; Extravasation; Vesicant; Tissue damage; Dimethyl sulfoxide; Dexrazoxane; Antidote; Hyaluronidase

Core tip: Chemotherapy administration carries safety concerns, which include accidental extravasation, to patients. We review and update readers and health care providers on the risks of chemotherapy extravasation, prevention and management. We present the definitions, grading, classification and guidelines related to chemotherapeutic drugs and groups. We present an update on prevention and management and antidotes, particularly dexrazoxane for anthracyclines extravasation. We present summary statements of American Society of Clinical Oncology, European Society of medical Oncology, Oncology Nursing Society and European Oncology Nursing Society guidelines. We stress the importance of education and training of the entire oncology team members who share responsibility to ensure the safe administration of chemotherapy and avoid extravasation.