Clinical results after doxorubicin extravasation treated with excision guided by fluorescence microscopy

Doxorubicin (DR) and epirubicin (ER) produce progressive tissue necrosis when extravasation occurs. Early detection and excision of all affected tissue is important. The clinical experience with fluorescence microscopic guided detection and excision in 24 patients is evaluated. 9 patients with fluorescence negative specimens were kept under observation without excision. None developed necrosis. Wide excision was performed on 15 patients with fluorescence positive specimens. Sequelae, defined as impaired function of the affected limb at the last control examination in the out-patient clinic, were observed in 8 patients. 4 of 5 patients with extravasation in the hand and 2 of 3 with extravasation 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. Patients developing sequelae had a median delay of roughly 4-fold that of 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 extravasation at other sites (P < 0.03). Our conclusions are: (1) fluorescence microscopic analysis is a reliable method for the detection and delineation 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 extravasation is suspected--delay leads to sequelae.