Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients
Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients
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DOI：
10.1007/s00261-012-9913-3
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发表时间：
2013-04-01
影响因子：
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通讯作者：
Lev-Toaff, Anna S.
中科院分区：
文献类型：
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作者：
Borofsky, Samuel E.;Levine, Marc S.;Lev-Toaff, Anna S.
目的探讨贝伐单抗治疗胃肠道(GI)并发症及其腹部影像表现。通过计算机检索，经腹部CT(n=11)和透视胃肠造影(n=4)确定11例符合我们研究标准的患者(其中卵巢癌5例，结肠癌5例，宫颈癌1例)。所有11例患者均有胃肠道穿孔的CT表现，或CT及胃肠道造影检查。CT显示8例(73%)局灶性穿孔患者(73%)有局限性的腔外气体、液体和/或造影剂聚集，3例(27%)自由穿孔患者有游离的腹部空气和液体。影像检查还发现7个瘘，包括2个阴道瘘、1个直肠阴道瘘、1个肠皮肤瘘、1个联合皮肤瘘、1个胃结肠瘘和1个结直肠瘘。11例患者中有8例(73%)在发生胃肠道穿孔后1年内死亡，其中4例(36%)被认为穿孔是死亡的原因。腹部CT和透视胃肠造影检查是诊断贝伐单抗治疗的潜在威胁生命的胃肠道穿孔的有用的影像检查。当腹部影像检查发现胃肠道穿孔时，贝伐单抗治疗应立即停止。
To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer, and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic findings in these patients.All 11 patients had findings of GI perforation on CT, or CT and GI contrast studies. CT revealed a localized extraluminal collection containing gas, fluid, and/or contrast material in eight patients (73%) with focal perforation, and free abdominal air and fluid in three (27%) with free perforation The imaging studies also revealed seven fistulas, including two colovaginal, one rectovaginal, one enterocutaneous, one colocutaneous, one gastrocolic, and one colorectal fistula. Eight (73%) of the 11 patients died within 1 year of the development of GI perforation, and the perforation was felt to be the cause of death in four patients (36%).Abdominal CT and fluoroscopic GI contrast studies are useful imaging tests for the diagnosis of potentially life-threatening GI perforation as a complication of bevacizumab therapy. When GI perforation is detected on abdominal imaging studies, treatment with bevacizumab should immediately be discontinued.