A comparison of regional versus systemic drug injection. Adriamycin concentration in peripheral blood and gastric stump (post-Billroth II gastrectomy) in the dog.

Gastric stump cancer has a low resection rate and poor response to systemic chemotherapy. This study attempted to achieve higher drug concentrations in target tissues by way of regional arterial injection instead of systemic venous administration. A total of 12 male mongrel dogs that had undergone post-Billroth II gastrectomies were randomly divided into two groups: in group A, 1.27 mg/kg adriamycin (ADM) was injected through the left gastric artery; in group B, the same dose of ADM was injected into a vein in the left front leg. Blood samples were taken at various time intervals, and the dogs were sacrificed 2 h after drug administration. Tissues were removed from various parts of the gastric stump for measurement of the ADM concentration. The ADM content in the jejunum, heart, liver, spleen, and pancreas was also determined. The results were as follows: (1) the ADM concentration in the gastric stump near its lesser curvature and stomal mucosa was significantly higher in group A than in group B (P less than 0.05). (2) The ADM concentrations in the adjacent organs (heart, liver, and pancreas) were also significantly higher in group A than in group B (P less than 0.05). (3) The ADM levels in the venous blood were significantly higher in group B than in group A (P less than 0.05). These results indicate that a chemotherapeutic drug given through the left gastric artery provides a higher drug concentration in the area where gastric stump cancer frequently occurs and that a lower systemic blood level may cause fewer adverse drug effects. The high concentration of ADM in the heart may not be a good indication, but it may serve as an important signal either to select a less cardiotoxic drug or to monitor heart function cautiously during drug therapy.