Case Western Reserve University School of Medicine, Health Education Campus, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Emerg Radiol. 2023 Aug;30(4):407-418. doi: 10.1007/s10140-023-02136-7. Epub 2023 May 2.
This study aims to highlight the presentations, imaging, and clinical outcomes of cancer patients presenting to the emergency department (ED) while receiving bevacizumab (Avastin) therapy.
Our retrospective study was based on data from a single institution to identify cancer patients who presented acutely to the ED between 2014 and 2021 within 3 months of beginning bevacizumab who subsequently received diagnostic imaging with CT, MRI, ultrasound, and/or nuclear medicine ventilation/perfusion (VQ) scans. Data gathered included presenting symptoms grouped by body system, imaging impressions, and clinical outcomes, including hospitalization and discontinuation of bevacizumab after each ED visit. Imaging examinations and patient charts were reviewed by a team of fellowship-trained radiologists, radiology residents, and medical students.
A total of 84 patients who presented to the ED were included for analysis. This included 32 (38.1%) males and 52 (61.9%) females, with a mean age of 61.2 years and an age range of 29-91 years. Neurological symptoms were the most common presenting symptoms, followed by abdominal symptoms and respiratory symptoms. Head imaging with CT and MRI was the most common imaging ordered with 55 total examinations, followed by abdominal imaging with 37 CT abdomen/pelvis (A/P) examinations, and then CT chest imaging with 22 examinations. Imaging revealed a serious adverse drug reaction in 21 (25.0%) patients, disease progression in 19 (22.6%), and no acute imaging findings in 44 (52.4%) patients. Imaging diagnoses were significantly associated with treatment planning, with a positive determination of bevacizumab-related serious adverse reaction on imaging leading to discontinuation of bevacizumab (p = 0.001).
Multimodality imaging was a commonly used assessment tool for cancer patients receiving bevacizumab who presented to the ED. Imaging played a crucial role in diagnosis in these patients, especially of treatment-related serious adverse reactions and disease progression. Positive imaging findings of serious adverse reactions affected patient management including discontinuation of bevacizumab.
本研究旨在强调在接受贝伐珠单抗（阿瓦斯汀）治疗期间前往急诊部（ED）就诊的癌症患者的临床表现、影像学表现和临床结局。
我们的回顾性研究基于单中心数据，纳入 2014 年至 2021 年间在开始接受贝伐珠单抗治疗后 3 个月内因急性病前往 ED 就诊的癌症患者，这些患者随后接受了 CT、MRI、超声和/或核医学通气/灌注（VQ）扫描的诊断性影像学检查。收集的数据包括按身体系统分组的就诊症状、影像学印象和临床结局，包括每次 ED 就诊后的住院和贝伐珠单抗的停用情况。影像学检查和患者病历由经过 fellowship培训的放射科医生、放射科住院医师和医学生组成的团队进行审查。
共纳入 84 例因 ED 就诊的患者进行分析。其中包括 32 例（38.1%）男性和 52 例（61.9%）女性，平均年龄为 61.2 岁，年龄范围为 29-91 岁。神经系统症状是最常见的就诊症状，其次是腹部症状和呼吸系统症状。头部 CT 和 MRI 检查是最常见的影像学检查，共进行了 55 次检查，其次是 37 次 CT 腹部/骨盆（A/P）检查，然后是 22 次 CT 胸部检查。影像学检查发现 21 例（25.0%）患者出现严重药物不良反应，19 例（22.6%）患者疾病进展，44 例（52.4%）患者无急性影像学发现。影像学诊断与治疗计划显著相关，影像学上确定与贝伐珠单抗相关的严重不良反应会导致贝伐珠单抗的停用（p=0.001）。
多模态影像学是接受贝伐珠单抗治疗并前往 ED 的癌症患者的常用评估工具。影像学在这些患者的诊断中发挥了关键作用，尤其是对治疗相关的严重不良反应和疾病进展的诊断。严重不良反应的阳性影像学发现影响了患者的管理，包括贝伐珠单抗的停用。
