演題番号 : P94-8
Bevacizumab has shown survival benefit in advanced or recurrent cervical cancer.With increased use of bevacizumab, serious adverse effects are being reported more frequently. Bowel perforation is a rare but often fatal adverse effects.We report a case of bowel perforation in a patient with recurrent cervical cancer treated with Bevacizumab.
A 75-year-old woman who had previous history of surgery for sigmoid colon cancer, was diagnosed stage1b1 cervical adenocarcinoma. Radical hysterectomy was done, and 6 cycles of paclitaxel and carboplatin chemotherapy were performed as adjuvant therapy. Four month after the end of adjuvant chemotherapy, she developed recurrence at vaginal stump and pelviclymph nodes. Although the remission was achieved after chemotherapy (S-1+oxalipolatin) and concurrent chemoradiotherapy (CCRT) with weekly-paclitaxel, the tumor recurrence at the same lesion was recognized 3 month after CCRT.
She was treated with paclitaxel-carboplatin with bevacizumab. After 2 cycles of chemotherapy, although the tumor disappeared, she had a lumber compression fracture and admitted to another hospital for rehabilitation. 2 months after the admission, she was transferred to our institution because of fever and vomiting. CT scan revealed the presence of ascites and the peritoneal free air. Bowel perforation was highly suspected and emergency exploratory laparotomy was performed. Sigmoid colon perforation was observed, and colostomy, intraperitoneal drainage and suture of perforation were performed.
In this case, there was history of surgery for sigmoid colon cancer and history of pelvic irradiation thereafter. Several risk factors for bowel perforation have been identified including history of bowel surgery, pelvic irradiation, and the presence of tumor. Bowel perforation is a fatal complication, and it is important to evaluate the risk factor before treatment with Bevacizumab.