右丙亚胺成功治疗蒽环类药物外渗的临床研究

Treatment of anthracycline extravasation with dexrazoxane

背景与目的:化疗过程中蒽环类药物的意外外渗是蒽环类药物的严重并发症,可导致组织严重创伤。以往,蒽环类药物外渗所致的较大创伤需要外科清创术和(或)皮肤移植而没有其他更好的治疗方法。近年来,临床前和临床资料显示右丙亚胺对于蒽环类药物导致的皮下损伤高度有效。本研究旨在观察右丙亚胺治疗蒽环类药物外渗的有效性和安全性。方法:80岁女性非何杰金淋巴瘤患者1例,蒽环类药物外渗后左手背红肿、溃破、剧烈疼痛,给予右丙亚胺静脉注射治疗(1000mg/m2,第1～2天,500mg/m2,第3天)。其有效性评定由彩色摄影和临床随访(1个月)评定。结果:患者应用右丙亚胺后,创面恢复迅速,治疗后第19天创面完全愈合,后遗症为局部轻微疼痛和色素沉着,手部功能无影响。但右丙亚胺可以增加化疗药物的骨髓抑制作用,对症处理后能缓解,未观察到其他不良反应。结论:尽管右丙亚胺治疗蒽环类药物外渗尚处于试验阶段,但其疗效令人鼓舞。本例临床研究表明该方法是有效的、安全的。

Background and purpose： Accidental extravasation of anthracycline in anticancer chemotherapy is a feared complication that may lead to progressive tissue damage. The condition may require extensive surgical intervention and often has severe long-term effects. So far, there has been no effective treatment against the devastating effect of extravasated anthracycline. However, dexrazoxane has proven highly effective in preventing necrosis in both preclinical and clinical studies. The purpose of this study was to assess the efficacy and safety of the treatment of anthracycline extravasation with dexrazoxane. Methods： The case of an 80-year-old woman with non-Hodgkin not treated lymphoma who experienced accidental extravasation of pegylated liposomal doxorubicin, the back of her left hand was red and edematous, festered and severely painful. She was treated with a 3-day schedule of i.v. dexrazoxane （1000 mg/m^2 at day 1 and day 2 follwed by 500 mg/m^2 at day 3）. The patient was assessed for efficacy with colored photograph and clinical symptom during the treatment period and regularly for the next 1 month. Results： The patient hospitalized due to the extravasation and to he assessable for efficacy of treatment, she recovered completely within 19 days with no surgery. Mild pain and mild pigmentation of the surrounding tissue were the sequelae observed. The function of the left hand was not affected. Hematologic toxicity was one of the common effects related to dexrazoxane. No other side effect was observed. Conclusion： Dexrazoxane is a promising agent for the treatment of patients who have accidental extravasation of anthracyclines. The efficacy and safety of the agent is worthy of further evaluation in the clinic.