Tumor fistulization associated with targeted therapy

Computed tomographic findings and clinical consequences

Henry Chow, Adam Jung, Jason Talbott, Amy M. Lin, Adil I. Daud, Fergus Coakley

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: To describe the computed tomographic (CT) appearances and clinical consequences of tumor fistulization as a complication of targeted therapy for cancer. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)86-90
Number of pages5
JournalJournal of Computer Assisted Tomography
Volume35
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Fistula
Neoplasms
Therapeutics
Gastrointestinal Tract
Health Insurance Portability and Accountability Act
Informed Consent
Abdomen
Air
Neoplasm Metastasis
Lung
Research

Keywords

  • angiogenesis inhibitor
  • bevacizumab
  • fistula
  • sunitinib
  • VEGF inhibitor

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Tumor fistulization associated with targeted therapy : Computed tomographic findings and clinical consequences. / Chow, Henry; Jung, Adam; Talbott, Jason; Lin, Amy M.; Daud, Adil I.; Coakley, Fergus.

In: Journal of Computer Assisted Tomography, Vol. 35, No. 1, 01.2011, p. 86-90.

Research output: Contribution to journalArticle

Chow, Henry ; Jung, Adam ; Talbott, Jason ; Lin, Amy M. ; Daud, Adil I. ; Coakley, Fergus. / Tumor fistulization associated with targeted therapy : Computed tomographic findings and clinical consequences. In: Journal of Computer Assisted Tomography. 2011 ; Vol. 35, No. 1. pp. 86-90.
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