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Gynecol Oncol. 2008 Feb;108(2):332-5.

Prevention strategies in palmar-plantar erythrodysesthesia onset: the role of regional cooling.

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  • 1IRCCS Ospedale San Raffaele, Obstetrics and Gynecology Department, Milan, Italy. mangili.giorgia@hsr.it



Palmar-plantar erythrodysesthesia (PPE) is a characteristic cutaneous toxicity associated with pegylated liposomal doxirubicin (PLD). Different therapies have been proposed to alleviate PPE onset. We performed a prospective study to evaluate preventive strategies to reduce PPE incidence in patients treated for gynecologic cancers.


Fifty-three patients were treated from 2001 to 2006 with PLD as single agent therapy or in combination with carboplatin or paclitaxel. PLD dosages were in the range of 30-50 mg/m2 every 21-28 days. All patients received premedication with dexamethasone and pyridoxine. Twenty-eight patients received application of ice packs on extremities during PLD infusion.


PPE was observed in 11 patients (20.8%). PLD administration as single agent or in combination and schedule of PLD therapy did not affect PPE incidence. A significant reduction in PPE onset was observed if PLD dosage was 30-35 mg/m2 (p=0.03) and when patients were submitted to regional cooling protocol (p=0.0097).


The use of ice packs around wrists and ankles is a simple and well tolerated prevention strategy and its efficacy is demonstrated in this study.

[PubMed - indexed for MEDLINE]
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