Finally, there are antidotes, such as dimethyl sulfoxide (DMSO), that scavenge the free radicals that are believed to cause tissue damage from doxorubicin. Dimethyl sulfoxide has been shown to be beneficial for anthracycline extravasations in both animal and human clinical trials.7,10,23,27,34 The concentration of DMSO used ranged from 55–99% and was applied topically with intermittent cool compresses.7,23,26 Some of the other beneficial properties of DMSO are its antiinflammatory, analgesic, and vasodilatory effects, and its ability to promote systemic absorption of the chemotherapeutic at local sites.24 However, the role for DMSO in the treatment of anthracycline extravasations has become secondary because of the efficacy of dexrazoxane for these exposures and the preparations necessary to make DMSO available in the clinical setting.21 Also, DMSO is not recommended with the use of dexrazoxane for the treatment of anthracycline extravasations. The systemic administration of dexrazoxane limits anthracycline-induced skin lesions in a murine model19 and used successfully in patients following doxorubicin20 and epirubicin15,19 extravasations. Dexrazoxane was given to these patients over 3 days intravenously at a starting dose of 1000 mg/m2. In two prospective, open-label, single-arm, multicenter clinical trials, the systemic administration of dexrazoxane within 6 hours of anthracycline extravasation resulted in the need for surgical resection of the wound site in only 1 of 54 (1.8%) patients.25 Dexrazoxane (Totect) is approved by the FDA for use in the treatment of anthracycline extravasation.16 This antidote is administered as an infusion over 15-30 min. at a site distant to that of the extravasation because of its irritating property. Cool compress at the site of the extravastion is discontinued for 15 minutes prior to therapy to promote the antidote's perfusion at the site. The dose of dexrazoxane (see Table SC3–1) is decreased for patients with diminished renal function (creatinine clearance < 40 mL/min). Patients need to be monitored with CBC and serum AST/ALT because dexrazoxane can cause reversible bone marrow suppression and elevated concentrations of these liver enzymes. Additional clinical evidence needs to be gathered to better define the medical management of other antineoplastic extravasations. Although the overall incidence of extravasations with antineoplastics is small, the associated morbidity may be significant. Prevention is the best form of therapy.