Tumor fistulization associated with targeted therapy: computed tomographic findings and clinical consequences.
Tumor fistulization associated with targeted therapy: computed tomographic findings and clinical consequences.
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DOI：
10.1097/rct.0b013e3181fce2cb
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发表时间：
2011-01
影响因子：
1.3
通讯作者：
Coakley FV
中科院分区：
文献类型：
--
作者：
Chow H;Jung A;Talbott J;Lin AM;Daud AI;Coakley FV
描述作为癌症靶向治疗并发症的肿瘤瘘管的计算机断层扫描 (CT) 表现和临床后果。人类研究委员会批准了这项符合健康保险流通和责任法案的研究，并放弃了书面知情同意书。根据资深作者和我们的多学科肿瘤委员会的记录，我们回顾性地确定了 4 名患者（1 名男性和 3 名女性，平均年龄为 55.25 岁；范围为 47 至 64 岁）在接受舒尼替尼组成的靶向治疗期间出现肿瘤瘘管（n = 2）；贝伐单抗（n = 1）； XL184，一种研究中的 c-Met 抑制剂 (n = 1)。对所有可用的临床、影像和组织病理学记录进行了审查，特别强调治疗、CT 结果和临床病程。所有 4 名患者均因腹部大转移沉积物（治疗前平均大小为 10.55 厘米；范围为 7.4-13.4 厘米）向胃肠道形成瘘管，一名患者还因大小不明的肺转移瘤向支气管树形成瘘管。所有瘘管均表现为先前存在的肿瘤块内出现空气。在检测到瘘管时，4 名患者其他部位的疾病显示出消退 (n = 1)、进展 (n = 2) 或稳定 (n = 1) 的迹象。目前，一名患者还活着，没有任何疾病证据，另外三名患者已经死亡。靶向治疗可与胃肠道或气管支气管树的肿瘤瘘管相关；熟悉 CT 结果应该有助于这种并发症的诊断，该并发症似乎具有可变性和患者特异性的预后意义。
To describe the computed tomographic (CT) appearances and clinical consequences of tumor fistulization as a complication of targeted therapy for cancer. The committee on human research approved this Health Insurance Portability and Accountability Act–compliant study and waived written informed consent. Based on the records of the senior author and our multidisciplinary Tumor Boards, we retrospectively identified 4 patients (1 man and 3 women with a mean age of 55.25 years; range, 47 to 64 years) who developed tumor fistulization while being treated with targeted therapy consisting of sunitinib (n = 2); bevacizumab (n = 1); and XL184, an investigational c-Met inhibitor (n = 1). All available clinical, imaging, and histopathological records were reviewed, with particular emphasis on treatment administered, CT findings, and clinical course. All 4 patients developed fistulae from large metastatic deposits in the abdomen (mean size before treatment, 10.55 cm; range, 7.4–13.4 cm) to the gastrointestinal tract, and one patient also developed fistulae from a lung metastasis of undetermined size to the bronchial tree. All fistulae manifested as the appearance of air within a pre-existing tumor mass. At the time of fistula detection, disease at other sites in the 4 patients showed signs of regression (n = 1), progression (n = 2), or stability (n = 1). Currently, one patient is alive without evidence of disease, and the 3 other patients are deceased. Targeted therapy can be associated with tumor fistulization to the gastrointestinal tract or tracheobronchial tree; familiarity with the CT findings should facilitate the diagnosis of this complication, which seems to be of variable and patient-specific prognostic significance.