title: Extensive bowel necrosis related to bevacizumab in metastatic rectal cancer patient: a case report and review of literature.
abstract: Recently, bevacizumab has become a key drug for treatment of metastatic colorectal cancer. Molecularly targeted agents such as bevacizumab can cause life-threatening adverse effects, though they are generally considered less toxic than cytotoxic drugs. Here, we review the case of a 76-year-old male rectal cancer patient with liver metastasis who suffered extensive bowel necrosis after administration of 5-fluorouracil-based chemotherapy with bevacizumab, and required a subtotal colectomy and end-ileostomy. Microscopic findings revealed extensive mucosal necrosis in the resected colon specimen and necrosis at the muscularis propria of the descending colon. Pathological findings suggested that the mucosal damage induced by chemotherapy may be exacerbated by treatment with bevacizumab, resulting in extensive necrosis.
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takada
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya Department of Surgery, Keio University School of Medicine, Shinjuku ymailbiz@gmail.com.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hoshino
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke.
authors.forename: Homare
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Pathology, Keio University School of Medicine, Shinjuku, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Masugi
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Terauchi
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Endo
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kimata
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Junji
authors.initials: J
authors.lastname: Furukawa
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Shinozaki
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Ogata
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000068258:Bevacizumab; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000473:pathology*; D017809:Fatal Outcome; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007081:Ileostomy / Q000379:methods; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D009336:Necrosis / Q000139:chemically induced / Q000601:surgery; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil
keywords: 5-fluorouracil; bevacizumab; intestinal perforation; metastatic colorectal cancer; necrosis