Chow Henry, Jung Adam, Talbott Jason, Lin Amy M, Daud Adil I, Coakley Fergus V
Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA.
J Comput Assist Tomogr. 2011 Jan-Feb;35(1):86-90. doi: 10.1097/RCT.0b013e3181fce2cb.
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.
描述肿瘤瘘形成作为癌症靶向治疗并发症的计算机断层扫描（CT）表现及临床后果。
人类研究委员会批准了这项符合《健康保险流通与责任法案》的研究，并免除了书面知情同意书。基于资深作者的记录以及我们的多学科肿瘤委员会，我们回顾性地确定了4例患者（1名男性和3名女性，平均年龄55.25岁；范围47至64岁），他们在接受由舒尼替尼（n = 2）、贝伐单抗（n = 1）和研究性c-Met抑制剂XL184（n = 1）组成的靶向治疗时发生了肿瘤瘘形成。回顾了所有可用的临床、影像和组织病理学记录，特别关注所给予的治疗、CT表现和临床病程。
所有4例患者均出现从腹部大的转移灶（治疗前平均大小10.55 cm；范围7.4 - 13.4 cm）至胃肠道的瘘管，1例患者还出现从大小未明的肺转移灶至支气管树的瘘管。所有瘘管均表现为在先前存在的肿瘤块内出现气体。在检测到瘘管时，4例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，1例患者存活且无疾病证据，其他3例患者已死亡。
靶向治疗可能与胃肠道或气管支气管树的肿瘤瘘形成有关；熟悉CT表现应有助于诊断这一并发症，其预后意义似乎因人而异且具有患者特异性。
