Geltzeiler Mathew, Steele Toby O
Department of Otolaryngology- Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA; University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA.
Am J Otolaryngol. 2017 May-Jun;38(3):354-355. doi: 10.1016/j.amjoto.2017.01.018. Epub 2017 Jan 19.
A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature.
We review the clinical record of a 59year old patient who presented with an anterior septal perforation while taking bevacizumab therapy for ovarian cancer. She had mild symptoms. Her oncologist held bevacizumab and topical moisture therapy was started. After several weeks, the perforation remained stable and bevacizumab was restarted for her ovarian cancer.
Bevacizumab is associated with both septal perforation and more widespread sinonasal toxicity. These lesions tend to produce only mild symptoms and can usually be managed conservatively. The decision to hold bevacizumab therapy should be made in conjunction with the patient and medical oncologist. Otolaryngologists should be aware of the toxicity from this increasingly common oncologic therapy.
本文报告了1例因系统性应用贝伐单抗治疗卵巢癌继发鼻中隔穿孔的病例。贝伐单抗是一种血管内皮生长因子A（VEGF - A）抑制剂，在肿瘤学界的应用越来越广泛。在耳鼻喉科特定文献中，仅有1篇关于贝伐单抗继发鼻中隔穿孔的既往报道。本报告的目的是：1）提高对贝伐单抗鼻窦并发症的认识并讨论相关文献，2）根据现有文献总结提供检查和治疗建议。
我们回顾了1例59岁患者的临床记录，该患者在接受贝伐单抗治疗卵巢癌时出现前鼻中隔穿孔。她症状轻微。她的肿瘤内科医生停用了贝伐单抗并开始局部保湿治疗。几周后，穿孔保持稳定，遂为其卵巢癌重新启用贝伐单抗。
贝伐单抗与鼻中隔穿孔及更广泛的鼻窦毒性有关。这些病变往往仅产生轻微症状，通常可采用保守治疗。停用贝伐单抗治疗的决定应与患者和肿瘤内科医生共同做出。耳鼻喉科医生应了解这种日益常见的肿瘤治疗的毒性。
