Trabectedin is a synthetic antineoplastic drug, binding to the minor groove of\nDNA and affecting DNA repair pathways, resulting in G2-M cell cycle arrest\nand apoptosis. Trabectedin has demonstrated high efficacy against various\nsoft tissue sarcomas. However, its extravasation causes serious complications,\nsuch as tissue necrosis and a delay in the treatment of underlying diseases.\nMethods: We experienced a rare case in which trabectedin extravasation\ncaused severe pectoralis major muscle necrosis. A 45-year-old man with multiple\nlung metastases of follicular dendritic cell sarcoma received 2.15 mg of\ntrabectedin totally through a central venous access device (CVAD) system in\nthe right precordium. Computed tomography showed extensive turbidity of\nsubcutaneous fatty tissue and swelling of the pectoralis major muscle to the\nupper margin of the liver, and the creatine kinase level was elevated to 759\nU/L (reference value from 54 to 286). We performed surgical debridement\ntwice, and the CVAD was concomitantly removed; thereafter, the skin defect\nwas reconstructed with a split skin mesh graft. Results: Histopathology\nshowed extreme degeneration of striated muscle and fatty tissue. Unfortunately,\ndisability of the right arm abducens persisted after treatment because\nof debridement around the right humerus muscle. Discussion: Several reports\nhave described cases of the extravasation of trabectedin. A few have\nmentioned severe muscular degeneration similar to that shown in the present\ncase. Because trabectedin is a strong vesicant cytotoxic agent, it is principally\nadministered through a CVAD rather than peripheral vessels and is continued\nduring the nighttime; this can lead to a delay in patients or attending\ndoctors noticing any extravasation. We need to spread appropriate knowledge\nof this drug and make an effort to prevent severe complications like in the present case.
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