Extravasation of Therapeutic Radiopharmaceuticals: A Systematic Review and Management Proposal

Area of Science:

• Nuclear Medicine
• Radiopharmaceutical Therapy
• Radiation Oncology

Background:

• Therapeutic radiopharmaceuticals are increasingly used, necessitating a clear understanding of extravasation risks.
• Extravasation, the leakage of radiopharmaceuticals outside the intended blood vessels, can lead to radiation-induced injury.
• Current management strategies for extravasation are varied, highlighting the need for standardization.

Purpose of the Study:

• To systematically review the consequences of therapeutic radiopharmaceutical extravasation.
• To analyze reported side effects and treatment approaches across different radiopharmaceuticals.
• To propose a standardized, step-by-step management guide for extravasation events.

Main Methods:

• Systematic literature search of MEDLINE and Embase databases.
• Inclusion of case reports on therapeutic radiopharmaceutical extravasation.
• Standardization of extracted data, including absorbed doses, side effects, and interventions.

Main Results:

• Analysis of 39 case reports from 28 publications.
• Side effect severity ranged from mild (swelling, pain) to severe (erythema, desquamation, necrosis), dependent on the radiopharmaceutical and absorbed dose.
• Limb mobilization was the most frequent intervention; prevention focused on vascular access.

Conclusions:

• Extravasation severity depends on infiltrated activity, retention, and radiation energy.
• Severe injuries occurred with radiosynoviorthesis and large molecules; none reported with PRRT or PSMA-targeted therapies.
• A standardized management guide is proposed to aid future clinical practice and guidelines.