title: Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients.
abstract: OBJECTIVE
  To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.
  
  
  METHODS
  A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer, and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic findings in these patients.
  
  
  RESULTS
  All 11 patients had findings of GI perforation on CT, or CT and GI contrast studies. CT revealed a localized extraluminal collection containing gas, fluid, and/or contrast material in eight patients (73%) with focal perforation, and free abdominal air and fluid in three (27%) with free perforation The imaging studies also revealed seven fistulas, including two colovaginal, one rectovaginal, one enterocutaneous, one colocutaneous, one gastrocolic, and one colorectal fistula. Eight (73%) of the 11 patients died within 1 year of the development of GI perforation, and the perforation was felt to be the cause of death in four patients (36%).
  
  
  CONCLUSIONS
  Abdominal CT and fluoroscopic GI contrast studies are useful imaging tests for the diagnosis of potentially life-threatening GI perforation as a complication of bevacizumab therapy. When GI perforation is detected on abdominal imaging studies, treatment with bevacizumab should immediately be discontinued.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Borofsky
authors.forename: Marc S
authors.initials: MS
authors.lastname: Levine
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Rubesin
authors.forename: Janos L
authors.initials: JL
authors.lastname: Tanyi
authors.forename: Christina S
authors.initials: CS
authors.lastname: Chu
authors.forename: Anna S
authors.initials: AS
authors.lastname: Lev-Toaff
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000188:drug therapy; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications; D007416:Intestinal Perforation / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D061330:Multidetector Computed Tomography; D010051:Ovarian Neoplasms / Q000188:drug therapy; D011860:Radiography, Abdominal / Q000379:methods; D012189:Retrospective Studies; D014624:Vaginal Fistula / Q000150:complications
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab