Bowel Perforation Occurred during Bevacizumab-containing Chemotherapy in a Patient with Metastatic Colon Cancer and Stent Placement for Obstruction

黃 慈恩, 呂 長賢, Chih-cheng Chen, 詹 宗晃, 吳 濬宇, 官 鋒澤, Kuan-Der Lee, 陳 秉聰

Research output: Contribution to journalJournal Article peer-review

Abstract

內視鏡腸道支架置入術目前廣泛運用於因大腸直腸癌造成腸阻塞並且有高手術風險的病患,在晚期及轉移大腸直腸癌的治療上,癌思停(bevacizumab)結合化療已被證實有明顯治療效果。我們提出一個病例報告是關於一個78 歲女性,因轉移性大腸癌造成腸阻塞而接受自動擴張性金屬支架(self-expandable metallic stent, SEMS)置入,然而在經過兩個循環的癌思停合併歐力普(oxaliplatin)、服樂癌(5-fluorouracil)、若克瘤(leucovorin)的治療後,發生了腸穿孔,因此馬上接受了緊急手術修補腸穿孔及腸造口。腸穿孔的危險因素包括癌思停為基礎的治療以及腸道支架置入。然而,以癌思停為基礎的處方運用在曾接受過腸道內支架置放的病人之安全性及腸穿孔之關聯性資料目前依舊缺乏。在此篇文章,我們同時搜尋了相關的研究報告,但多為病例報告,且僅一篇回溯性研究報告提及在經過腸道支架置放後,接受癌思停治療有增加腸穿孔的比率但未達到統計學上意義。因此我們認為仍需要進一步大型前瞻性研究來澄清癌思停是否會相對增加接受腸道支架置入術的病人腸穿孔的危險性。
Endoscopic stent placement is used widely for bowel obstruction in patients with colorectal cancer and poor risk for surgery. The efficacy of bevacizumab is documented when it is used in combination with chemotherapy for advanced or metastatic colorectal cancer. We present the case of a 78-year-old woman who had received self-expandable metallic stent (SEMS) placement for bowel obstruction induced by sigmoid colon adenocarcinoma. However, after two courses of regimen of bevacizumab plus oxaliplatin, 5-fluorouracil, and leucovorin, bowel perforation developed. The patient received emergent laparotomy with radical protectomy and colostomy. Bowel perforations have been related to several risk factors, including bevacizumabbased therapy and stent placement. However, the data on safety of bevacizumab-containing therapies for patients carrying stent placement is lacking. In this article, we also review associated case reports and studies. Only one retrospective study reported higher but not statistically significant increased risk of bowel perforation in patients receiving bevacizumab-based therapy after SEMS placement. In conclusion, further large controlled trials are needed to clarify the association between bevacizumab and risk of bowel perforation in patient with SEMS placement.
Original languageAmerican English
Pages (from-to)31-36
Journal臺灣癌症醫學雜誌
Volume27
Issue number1
StatePublished - 2011

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