Should i.m. injections be avoided during cancer chemotherapy?

The intravascular transit of malignant tumor cells constitutes an important step in the formation of distant metastases. The development of tumors in extravascular tissues depends upon the exit of these cells from the circulation by crossing the barriers formed by endothelium and basement membrane and their growth in the extravascular environment. Cytostatic drugs may disturb the function of these barriers and some of them, as well as antiemetic drugs, are given as i.m. injections. Thus these both mechanically and chemically induced endothelial and extravascular tissue changes might facilitate tumor cell transit to extravascular tissues. These aspects are discussed in this case report of a young female patient with a mediastinal germ cell tumor. At 4 years after complete remission induced with chemotherapy and radiotherapy she developed recurrent germ cell tumor in the form of a s.c. gluteal abscess. This gluteal region is the most common site of i.m. injections during or after cancer chemotherapy.