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Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients:
Abstract
Methods
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.
Results
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%).
Conclusion
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.
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