Toxicity of intra-arterial doxorubicin in locally advanced breast cancer

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Abstract
Four patients with inoperable, locally advanced breast cancer were treated i.a. with 25–35 mg/m2 doxorubicin given as a 6-h infusion on 2 successive days. In each patient, the catheter was introduced percutaneously via the femoral or brachial artery using local anaesthetic and positioned in the internal mammary artery, without complications. However, within 48 h of starting treatment all four patients developed extensive erythema over the chest wall, which progressed to superficial ulceration in one case. Two patients also developed a raised hemidiaphragm and phrenic nerve paralysis that was associated with a pleural effusion in one case. This study closed prematurely because of unacceptable local toxicity; thus, we cannot assess the activity of doxorubicin given in this way. If this approach to local control is to be tested further in locally advanced breast cancer, lower doxorubicin doses should be used, or different drugs selected.