Bronchial Necrosis Following Bevacizumab and Stereotactic Body Radiotherapy for Treatment of Metastatic Breast Cancer

Umar Osman,Christopher R Gilbert

doi:10.4172/2161-105x.1000345

Abstract

Bevacizumab is an emerging therapy with widespread use in the treatment of advanced malignancies. We describe a young female with metastatic breast cancer that underwent stereotactic body radiation during treatment with bevacizumab after the discovery of a new metastatic focus within the lung parenchyma. Approximately one year later she presented with a progressive foul smelling cough and dyspnea. Bronchoscopy revealed extensive necrotic destruction of the bronchus intermedius. Airway necrosis may be a rare adverse event associated with the use of bevacizumab, especially with concomitant radiotherapy.

Highlights

Airway necrosis remains a rare, but potentially fatal problem
Bevacizumab use has been associated with numerous adverse events including spontaneous pulmonary hemorrhage, gastrointestinal perforation, and thromboembolic events [5,6], including a recent report suggesting that airway complications and cavitation may be more common than initially described [3]
We present a case of airway necrosis observed after the use of stereotactic radiotherapy and bevacizumab to treat metastatic breast cancer

Summary

Introduction

Airway necrosis remains a rare, but potentially fatal problem. Necrosis is described in association with radiotherapy [1,2] but has recently been described in relation to chemotherapeutic agents utilized for lung cancer [3,4]. She received neoadjuvant chemotherapy (doxorubicin, cyclophosphamide, and paclitaxel) followed by bilateral mastectomies She appeared to have no evidence of disease on follow-up imaging, in August 2013 she presented with headaches and imaging demonstrated brain lesions as well as a lung mass (Figure 1a). Transthoracic needle aspiration of the lung mass demonstrated cytology consistent with her previously diagnosed breast carcinoma She was started on bevacizumab and received stereotactic body radiation therapy in five fractions over 10 days (total of 5000 cGy) to the lung lesion as well as whole brain radiation. Chest imaging revealed evidence of what appeared to be a new right main stem bronchus defect At this same time she developed a right-sided pneumothorax requiring chest tube placement, thought to be related to an attempted central line placement during her initial volume resuscitation. She was transitioned to hospice and comfort measures were undertaken, expiring one month after admission

Discussion

Conclusion