Grasic Kuhar C et al. / Digital ischemic events related to gemcitabine 261 with iloprost prometanol have been proven helpful in resolving microcirculation in both cases as docu- mented by control plethysmography. Additionally calcium channel blockers and other vasodilata- tors were shown beneficial in resolving digital ischemia.6,7,11 Conclusions Digital ischemic events associated with gemcitab- ine chemotherapy seem to be more common than previously thought, especially when used in com- bination with platinum salts and in patients with tobacco-associated cancers. In patients with known risk factors for PAOD, like dislypidemia, arterial hypertension, diabetes or tobacco smoking, and a history of intermittent claudication thorough the examination of peripheral pulses should be per- formed before the initiation of gemcitabine or plat- inum-gemcitabine doublet. In addition, if painful trophic digital changes develop while on therapy with gemcitabine, medical oncologists should re- fer the patient to an angiologist for the assessment of impaired micro or macrocirculation. In case of diagnosis of ischemic vascular event, discontinua- tion of gemcitabine and immediately therapy with prostacycline analogues should be initiated. The early diagnosis and the appropriate intervention improve not only the outcome of the ischemic vas- cular event but also the quality of life of the patient. References 1. Dasanu CA. Gemcitabine: vascular toxicity and prothrombotic potential. Expert Opin Drug Saf 2008; 7: 703-16. 2. Summary of Product Characteristics of Gemcitabine; date of revision 18 February 2009: http://emc.medicines.org.uk/medicine/596. 3. Debevec L, Jeric T, Kovac V, Bitenc M, Sok M. Is there any progress in routine management of lung cancer patients? A comparative analysis of an instituti- on in 1996 and 2006. Radiol Oncol 2009; 43: 47-53. 4. Kovač V, Smrdel U. Meta-analyses of clinical trials in patients with non-small cell lung cancer. Neoplasma 2004; 51: 334-40. 5. Izzedine H, Isnard-Bagnis C, Launay-Vacher V, Mercadal L, Tostivint I, Rixe O, et al. Gemcitabine-induced thrombotic microangiopathy: a systematic review. Nephrol Dial Transplant 2006; 21: 3038-45. 6. Kyung RH, Chan K, Un JP. Successful treatment of digital ulcers in a scle- roderma patient with continuous infusion bilateral thoracic sympathetic block. Pain Physician 2008; 11: 91-6. 7. Barcelo R, Lopez-Vivanco G, Mane JM, Rubio I, Munoz A, Fernandez R. Distal ischemic changes related to combination chemotherapy with cisplatin and gemcitabine. Description of four cases. Ann Oncol 2000; 11: 1191-4. 8. Venat-Bouvet L, Szelag JC, Martin J, Labourey JL, Genet D, Tubiana-Mathieu N. Thrombotic microangiopathy and digital necrosis; two unrecognized toxicities of gemcitabine. Anticancer Drugs 2003; 14: 829-32. 9. Blaise S, Appeltants H, Carpentier PH and Debru JL. Digital ischemia and gemcitabine. Twoo new cases. J Mal Vasc 2005; 30: 53-7. 10. Holstein A, Batge R, Egberts EH. Gemcitabine induced digital ischemia and necrosis. Eur J Cancer Care (Engl) 2009. [Epub ahead of print] 11. Clowse MEB, Wigley FM. Digital necrosis related to carboplatin and gemcit- abine therapy in systemic sclerosis. J Rheumatol 2003; 30: 1341-3. 12. D’Alessandro V, Errico M, Varriale A, Greco A, De Cata A, Carnevale V, et al. Case report: acro-necrosis of the upper limbs caused by gemcitabine therapy. Cli Ter 2003; 154: 207-10. 13. Hummers LK, Wigley FM. Management of Raynaud’s phenomenon and digital ischemic lesions in scleroderma. Rheum Dis Clin North Am 2003; 29: 293-313. 14. Buch RS, Geisbüsch R, Kunkel M. Acral ischemia as a rare paraneoplastic syndrome in the terminal phase of mouth floor carcinoma. [German]. Mund Kiefer Gesichtschir 2002; 6: 331-5. 15. Aschauer MA, Ebner F, Stollberger R. Advances in contrast-enhanced MR- angiography. Radiol Oncol 2002; 36: 103-8. Radiol Oncol 2010; 44(4): 257-261.