Background Chemoembolization of iodized oil into a hepatic tumour (hioCE) is a locoregional medical technique that consists of delivering selectively into tumour-feeding arteries, an anticancer drug emulsified in iodized oil followed by an occlusive agent (embolization agent). It enables higher intra-tumour drug concentrations to be obtained compared to intravenous treatment, with blood vessel occlusion causing local necrosis. hioCE using doxorubicin at 50 mg/m² is effective in the palliative treatment of hepatocellular carcinoma (HCC) with significant survival benefit compared with best supportive care. To our knowledge, no study has evaluated systemic doxorubicin toxicity after hioCE.

Purpose To evaluate systemic doxorubicin toxicity in HCC patients treated by hioCE.

Materials and Methods A 3-year retrospective study was performed in the Radiology and Pharmacy departments. Toxicity was assessed using WHO criteria. Data were collected from Chimio software and patient medical records. Mann Whitney and Chi2 tests were used.

Results 94 HCC patients were treated with hioCE using doxorubicin. Median age was 64 years [28–89]. Toxicity occurred in 69 patients (73%). Main toxicities were digestive disorders (34 patients; 16 grade 3–4), cardiotoxicity (16 patients; 10 grade 3–4) and alopecia (13 patients; 8 grade 3–4). No statistical relationship was found between patient characteristics (age, sex, body mass index, medical and surgical history), HCC aetiology or characteristics, Child-Pugh score or hioCE practise and the occurrence or gravity of doxorubicin toxicity.

Conclusions More than half of the patients suffered doxorubicin toxicity after hioCE suggesting doxorubicin passed into the systemic circulation. Studies showed that the doxorubicin-iodized oil mixture was unstable. Although hioCE with doxorubicin is effective in HCC and doxorubicin toxicity occurring in our patients was less severe than that of intravenous doxorubicin administration, doxorubicin tolerance after hioCE is debatable. The use of an anticancer drug that was more stable with iodized oil could decrease the passage of the drug into the systemic circulation. The use of doxorubicin-eluting beads for chemoembolization is much more expensive but could also be an alternative.

No conflict of interest.