Reply to "Early subcutaneous wash-out in acute extravasations", by R. Giunta (Ann Oncol 2004; 15: 1146), and to the reply by D. Schrijvers (Ann Oncol 2004; 15: 1147)
Dr Schrijvers's reply [1
] to Dr Giunta's letter to the editor [2
] suggests that an animal model might be used to test whether the technique of subcutaneous wash-out is useful in the treatment of chemotherapy extravasation. At ASCO 1999, we presented a poster in which we described a different therapeutic approach to skin ulcerations induced by doxorubicin [3
]. Based on data that showed smaller ulcer diameter with high vesicant drug concentration dilution, we compared two groups of rats (n=30) that received intradermic doxorubicin. One group was subjected to skin incisions (25 scalpel incisions <8 mm) and saline solution washes, while the other group underwent only observation after doxorubicin injection. The conclusions of our work were clinical evidence of later ulcer appearance, earlier disappearance and smaller ulcer area, and a tendency for premature healing in the group of rats which were treated with wash-out procedures after the extravasations of a vesicant agent. I agree with both authors that all treatment options for drug extravasations must be considered, but nurse, patient and doctor education is still the best approach to avoid tissue injuries.
M. R. Chacon*
Alexander Fleming Institute, Medical Oncology, Buenos Aires, Argentina
* Email: matiemi{at}yahoo.com
References
1. Schrijvers D. Reply to Early subcutaneous wash-out in acute extravasations] by R. Giunta. (Ann Oncol 2004; 15: 1146). Ann Oncol 2004; 15: 1147.[Free Full Text]
2. Giunta R. Early subcutaneous wash-out in acute extravasations. Ann Oncol 2004; 15: 1146.[Free Full Text]
3. Chacon M, Ricart A, Huertas E et al. A different therapeutic approach to skin ulcerations (ULC) induced by doxorubicin (DOX). Proc Am Soc Clin Oncol 1999; 18: 194a (Abstr 748).