The effect of chemotherapeutic agents on wound healing

A review of experimental studies of chemotherapeutic agents and wound healing has demonstrated impairment of healing by a wide variety of agents. The extent of impairment by several agents (corticosteroids, Adriamycin, methotrexate, and cyclophosphamide) is dependent upon the interval between administration and wounding. If given within three to four days of wounding significant impairment results, but beyond that interval, impairment is minimal. Studies in animals with some agents (adriamycin, nitrogen mustard, cyclophosphamide, and methotrexate) have shown a dose-dependent impairment of healing, but extrapolation of these doses to regimens employed in man is impossible. Information regarding complications of chemotherapeutic agents in wound healing in man is available from adjuvant studies. No increased frequency of complications from nitrogen mustard, thio-TEPA, or cyclophosphamide occurred, even when these agents were given in the immediate perioperative period. Increased wound complications occurred with 5-fluorouracil when a 60 mg/kg dose was begun seven days after surgery but not when it was begun 14 days after surgery. These results stress the need for continued attention to wound complication occurring in adjuvant studies, and suggest that delay of treatment until seven days after surgery should produce minimal impairment.