Extravasation of epirubicin/vincristine and ifosfamide/ mesna from a central venous catheter

Abstract

A 50-year-old female diagnosed with high-grade infil trating ductal carcinoma of the left breast was planned for insertion of a central venous catheter for a 6-week continuous infusion regimen including weekly ifosfamide/mesna alternating with weekly epi rubicin/vincristine via a CADD portable infusion pump; then radiotherapy followed by a further 6 weeks of VIE infusional chemotherapy.

The initial 6 weeks of therapy was complicated by infected central venous catheter during week 2. Central venous catheter was removed and chemother apy was administered peripherally. After completion of XRT, a new central venous catheter was inserted and the second cycle of epirubicin/vincristine chemo therapy was commenced.

During week 3 of the second cycle the patient developed right neck pain and swelling, which was diagnosed as a haematoma and cellulitis which was treated with cephalexin. The following week she was admitted for intravenous antibiotics and drainage of the haematoma. Exploration of the neck swelling revealed fat necrosis and extravasation of chemother apy into the subcutaneous tissues. Chemotherapy was stopped, and treatment was commenced for extrava sation of an unknown volume of ifosfamide/mesna administered weeks 1 and 3, and epirubicin/vincris tine administered weeks 2 and 4 for unknown period, possibly 3 weeks.

The extravasation was treated as per the institu tional policy for anthracycline extravasation; topical dimethyl sulphoxide and cold packs were applied every six hours for 14 days and plastic surgeons were consulted. Central venous catheter was removed 10 days after detection of the extravasation. Inflamma tion and pain resolved slowly over 4 weeks. The patient has had no further chemotherapy, and re mains in CR. There have been no long-term sequelae from the extravasation.