Abstract
Purpose While the precise technique for DEB administration has not been completely elucidated, the most recent recommendations suggest delivering the beads as a drug delivery system and maintaining tumor perfusion rather than continuing to complete tumor stasis that may induce further angiogenesis. It is unclear how intratumoral and systemic doxorubicin levels are affected by DEB delivery performed with or without vascular stasis. Avoiding embolization may facilitate drug washout, reduce tumor doxorubicin concentrations, and increase systemic exposure to chemotherapy. We hypothesized that there would be a decrease in systemic doxorubicin exposure following DEB versus systemic chemotherapy and chemoembolization to stasis versus delivery without stasis. Materials and Methods Dogs diagnosed with naturally occurring nonresectable HCC were scheduled to receive three separate treatments ~5 weeks apart containing the same systemic dose of doxorubicin; 1) 100-300 DEB delivered without stasis, 2) 100-300 DEB delivery followed by Beadblock to stasis, and 3) intravenous doxorubicin. Serum doxorubicin levels were measured postoperatively. Results Serum doxorubicin levels were detectable for a median of 180, 30, and 1080 minutes following delivery without stasis (5 dogs), with stasis (7 dogs), and intravenously (4 dogs), respectively. Median maximum serum doxorubicin levels, median area-under-the-curve systemic doxorubicin levels, and median relative systemic doxorubicin exposures are reported in the Table . Conclusion Different DEB chemoembolization techniques may achieve different serum doxorubicin concentrations and therefore different intratumoral drug concentrations. When performing DEB chemoembolization in dogs with naturally occurring hepatocellular carcinoma, delivery to stasis results in the lowest systemic doxorubicin exposure (and presumably higher intratumoral concentrations) than when embolization to stasis in not performed.
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