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Tumor Fistulization Associated With Targeted Therapy: Computed Tomographic Findings and Clinical Consequences

Chow, Henry DO; Jung, Adam MD, PhD; Talbott, Jason MD, PhD; Lin, Amy M. MD; Daud, Adil I. MD; Coakley, Fergus V. MD, MB, BCh

Journal of Computer Assisted Tomography: January-February 2011 - Volume 35 - Issue 1 - p 86-90
doi: 10.1097/RCT.0b013e3181fce2cb
Original Articles

Purpose: 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.

From the Department of Radiology, University of California San Francisco, San Francisco, CA.

Received for publication July 16, 2010; accepted September 14, 2010.

Reprints: Fergus V. Coakley, MD, MB, BCh, University of California San Francisco, Box 0628, M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628 (e-mail:

JT was supported by NIBIB T32 Training Grant 2T32EB001631-06.

© 2011 Lippincott Williams & Wilkins, Inc.