Tumor fistulization associated with targeted therapy: computed tomographic findings and clinical consequences.
OBJECTIVE
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.
Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA.
Henry
H
Chow
Adam
A
Jung
Jason
J
Talbott
Amy M
AM
Lin
Adil I
AI
Daud
Fergus V
FV
Coakley
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068258:Bevacizumab; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005402:Fistula / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D007472:Iohexol; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology; D000077210:Sunitinib; D014057:Tomography, X-Ray Computed
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D003287:Contrast Media; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000068258:Bevacizumab; D007472:Iohexol; D000077210:Sunitinib
Gynecol Oncol. 2007 Apr;105(1):3-6
17383545
N Engl J Med. 2004 Jun 3;350(23):2335-42
15175435
Lancet. 2006 Oct 14;368(9544):1329-38
17046465
World J Gastroenterol. 2010 Jun 14;16(22):2726-34
20533592
N Engl J Med. 2007 Jan 11;356(2):115-24
17215529
J Cancer Res Clin Oncol. 2010 May;136(5):737-43
19904559
Invest New Drugs. 2008 Feb;26(1):95-6
17962908
J Clin Oncol. 2006 Jan 1;24(1):25-35
16314617