Tumor fistulization associated with targeted therapy: computed tomographic findings and clinical consequences

• Published in: Journal of computer assisted tomography Vol. 35; no. 1; p. 86
• Main Authors: Chow, Henry, Jung, Adam, Talbott, Jason, Lin, Amy M, Daud, Adil I, Coakley, Fergus V
• Format: Journal Article
• Language: English
• Published: United States 01.01.2011
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Aged; Angiogenesis Inhibitors - adverse effects; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Bevacizumab; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - pathology; Colonic Neoplasms - drug therapy; Colonic Neoplasms - pathology; Contrast Media; Female; Fistula - chemically induced; Fistula - diagnostic imaging; Fistula - pathology; Gastrointestinal Stromal Tumors - drug therapy; Gastrointestinal Stromal Tumors - pathology; Humans; Indoles - adverse effects; Indoles - therapeutic use; Iohexol; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - drug therapy; Male; Melanoma - drug therapy; Melanoma - pathology; Middle Aged; Protein Kinase Inhibitors - adverse effects; Protein Kinase Inhibitors - therapeutic use; Pyrroles - adverse effects; Pyrroles - therapeutic use; Retrospective Studies; Skin Neoplasms - drug therapy; Skin Neoplasms - pathology; Tomography, X-Ray Computed
• ISSN: 1532-3145
• 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.