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CORRESPONDENCE Recall Reaction of a Severe Local Peripheral Neuropathy After Paclitaxel Extravasation Peripheral neuropathy with numbness, tingling, and burning pain in a glove-and-stocking distribution is the most common nonhematologic side effect associated with paclitaxel (Taxol) therapy, whereas nerve damage leading to motor dysfunction is uncommon (J). We report here on a 53-year-old man with both non-insulin-dependent diabetes mellitus without systemic complications and locally advanced non-small-cell lung cancer. The patient was started on paclitaxel that was administered through the right antecubital vein at 175 mg/m2 in a 3-hour infusion (total dose, 360 mg). He also received standard recommended premedication and carboplatin; the carboplatin dose was targeted to an area under the curve for drug concentration as a function of time of 7 (total dose, 1080 mg). During the infusion of paclitaxel, an extravasation of approximately one fifth of the dose occurred. The rest of the paclitaxel dose followed by carboplatin was given through peripheral access in the left arm. The patient had no immediate symptoms resulting from the extravasation, and no specific measures were taken. Inflammation at injection sites with soft-tissue reactions has been reported after paclitaxel extravasation (2), but no specific management of this adverse effect is recommended at the present time. One week after treatment, the patient experienced burning pain, extending from the right elbow to the right wrist; paresthesia, sensory loss, and motor weakness developed in this area. These symptoms increased during the next week. In the third week, they gradually began to subside in a cranio-caudal fashion. A physical examination at 21 days showed motor weakness with sensory deficit in the median nerve of the right arm. 1320 CORRESPONDENCE A second course of chemotherapy with the same agents, doses, and schedule was conducted with infusion through the left antecubital vein without any incident. Three weeks later, however, the patient reported a worsening of the symptoms in his right arm, with lancinating pain, sensory loss, weakness, and severe functional deficit. Neurologic examination disclosed weakened muscles innervated by both the right median and radial nerves, with sensory loss in the areas of these nerves. Electrophysiology was consistent with incomplete axonotmesis of both right median and radial nerves, normal nerve conduction, normal sensory and motor action potentials, and the presence (in a needle electromyographic study) of fibrillations and positive sharp waves in the right musculus abductor pollicis brevis, right musculus brachioradialis, and right triceps. Examination of the ulnar nerve revealed no abnormalities. No other sign or symptom of neurotoxicity was present in other areas. Treatment for pain was intensified with carbamazepine and amitriptyline; no further paclitaxel was given. With a 2month follow-up period, signs and symptoms of neutrotoxicity have been decreasing slowly but progressively. In our patient, the distribution of neurologic symptoms in the area in which paclitaxel extravasated, coupled with the absence of any neurologic disturbances in other regions, suggests that local exposure to paclitaxel was responsible for the clinical picture. As far as we know, this side effect has not been reported previously. The important recall reaction after systemic re-exposure to paclitaxel implies that, in the case of focal neuropathy after paclitaxel extravasation, serious consideration should be made regarding further therapy with this agent. MANUEL HIDALGO JULIAN BENITO RAMON COLOMER LUIS PAZ-ARES (2) Ajani JA, Dodd LG, Daugherty K, Warkentin D, Ilson DH. Taxol-mduced soft-tissue injury secondary to extravasation: characterization by histopathology and clinical course. J Natl Cancer Inst 1994:86:51-3. Notes Affiliations of authors. M. Hidalgo, R. Colomer, L. Paz-Ares (Division of Medical Oncology), J. Benito (Division of Neurology), University Hospital " 12 de Octubre," Madrid, Spain. Correspondence to: Manuel Hidalgo, M.D., Division of Medical Oncology, University Hospital '12 de Octubre," Avd Cdrcloba Km 5, 4, 28041 Madrid, Spain. Erratum: "Clinicopathologic and Prognostic Significance of an Angiogenic Factor, Thymidine Phosphorylase, in Human Colorectal Carcinoma," by Takebayashi et al. [J Natl Cancer Inst 1996;88:1110-7 (Issue 16)1. The first sentence of paragraph two of "Patients and Methods" should read, "Monoclonal antibodies were raised against a glutathione S-transferase (GST)-dThdPase fusion product containing 244 amino acids of dThdPase (amino acid residues 7-250)." This is the only tug your heart should feel It's never too late to quit smoking. Call 1-S0O-4-CANCER. References (/) Rowinsky EK, Chaudhry V, Comblath DR. Donehowcr RC. Neuroloxicity of Taxol. Monogr Natl Cancer Inst 1993:15:107-15. Journal of the National Cancer Institute, Vol. 88, No. 18, September 18, 1996