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Does Stent Placement for Advanced Colon Cancer Increase the Risk of Perforation During Bevacizumab-Based Therapy?

https://doi.org/10.1016/j.cgh.2009.07.015Get rights and content

Background & Aims

Data on the safety of bevacizumab-based therapies for patients carrying a self-expandable metallic stent (SEMS) for occlusive colon cancer are lacking. We report 2 cases of colon perforation observed in our case series of patients with SEMS for occlusive colon cancer.

Methods

Patients with occlusive symptoms caused by colon cancer received a colonic stent under endoscopic and radiologic guidance.

Results

Over a 10-month period, 28 patients with occlusive colon cancer were treated with stent placement. The stent was placed as a bridge to surgery in 12 patients who were treated surgically within 4 to 78 days after the endoscopic procedures, without any stent-related complications. Seven patients did not receive any other antitumor treatment as a result of concomitant comorbidities. Nine patients with both primary tumor and metastatic lesions were treated with medical therapy. Over a median follow-up period of 131 days colonic perforation occurred in the 2 patients treated with a combination of capecitabine and oxaliplatin plus bevacizumab.

Conclusions

Further studies are needed to clarify whether SEMS placement increases the risk of perforation caused by bevacizumab-based therapies.

References (20)

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    Citation Excerpt :

    BV is broadly used in patients with advanced CRC, and gastrointestinal perforations represent a well-known but infrequent complication, occurring in every 60 to 200 treated patients.11,12,29 Patients with occlusive colon cancer treated with stent placement and scheduled for BV-based therapy may have an increased risk of colon perforation,27,28 with SEMS placement representing an additional factor that further increases such risk. However, despite observing more stent-related complications in patients treated with BV-based regimens, patients with metastatic colon cancer benefit from chemotherapy and antiangiogenic agents after SEMS implantation, showing an association with survival.

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Conflicts of interest The authors disclose no conflicts.

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