paywalled: 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:

Abstract

Aim

To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.

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.

EvidenceUpdates - abstract/commentaries: Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre r

 Note: this study was originally published in The Lancet and involved patients in 25 hospitals; the study pertained to left-sided colorectal cancers however may be appropriate/of interest to other cancer patient populations; commentaries are included from a variety of professions including gastroenterologist, oncologists...

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BACKGROUND: Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction, but its benefits are uncertain. We aimed to establish whether colonic stenting has better health outcomes than does emergency surgery.

Septal Perforation - Medical Aspects: eMedicine Otolaryngology and Facial Plastic Surgery

Septal Perforations

Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma