Role of dimethylsulfoxide for management of chemotherapy extravasation

Abstract

Extravasation of anthracyclines is a rare complication that can lead to severe tissue necrosis and ulceration. With conservative measures (e.g., limb elevation, cooling), ulceration may develop in 28% of patients. Topical dimethylsulfoxide is commonly suggested as an antidote. However, there are inconsistent and sometimes conflicting animal data on its efficacy and safety. Ovid Medline (1966 to April 2004) was searched using the medical subject headings of ‘Dimethyl Sulfoxide’ and ‘Extravasation of Diagnostic and Therapeutic Materials’, and limited to English language and human articles. There have been no controlled trials on dimethylsulfoxide comparing its efficacy with cooling alone. Of a total of 147 patients, ulceration was uncommon after anthracycline extravasation when patients were managed with dimethylsulfoxide with or without cooling. Dimethylsulfoxide was well tolerated, with the most common toxicities being early mild reversible burning sensation, blistering, followed later by itch, erythema and superficial scaling. Dimethylsulfoxide is probably effective in preventing ulceration in patients who may not respond to cooling alone. When applied appropriately, dimethylsulfoxide seems well tolerated, with self-limiting local irritation to be the most common adverse effect. Hence, it is reasonable to consider topical dimethylsulfoxide 99% solution when managing extravasation of anthracyclines and mitomycin.