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Benitez Fuentes JD, Lopez de Sa Lorenzo A, Calvo Elias AE, Toledano Rojas C, Granja Ortega M. Perforation of the Nasal Septum in a Colorectal Cancer Patient Treated With Aflibercept: A Case Report. Cureus 2022; 14:e26780. [PMID: 35836714 PMCID: PMC9275094 DOI: 10.7759/cureus.26780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/15/2022] Open
Abstract
Aflibercept is an antiangiogenic agent used in patients with metastatic colorectal cancer who have progressed to a first-line oxaliplatin-based regimen. The main adverse effects (AEs) of antiangiogenic agents are fatigue, asthenia, anorexia, hypertension, proteinuria, urinary tract infection, diarrhea, and neutropenia. Other AEs, such as hemorrhage, thromboembolic events, and gastrointestinal perforation, are much less frequent. Nasal septal perforation caused by antiangiogenic agents is even rarer. The published literature on this subject is scarce. Here, we report the case of a 54-year-old male with metastatic colorectal cancer undergoing treatment with leucovorin, fluorouracil (5-FU), irinotecan, and aflibercept who presented with epistaxis and nasal congestion. An otolaryngologist performed a rhinoscopy that revealed a perforation of the nasal septum. Aflibercept was withdrawn first, and local treatment was applied with lubricant and antibacterial lotions. It was considered a non-life-threatening side effect, and given the high risk of not continuing treatment in this patient with a recent recurrence, aflibercept was reintroduced in combination with leucovorin, 5-FU, and irinotecan. The patient continued local treatment and follow-up with medical oncology and otolaryngology with gradual improvement of symptoms. Follow-up was discontinued due to disease progression and death after 16 months of the event.
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Rosenthal JC, Wisotzky EL, Matuschek C, Hobl M, Hilsmann A, Eisert P, Uecker FC. Endoscopic measurement of nasal septum perforations. HNO 2021; 70:1-7. [PMID: 34633475 PMCID: PMC8837565 DOI: 10.1007/s00106-021-01102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
Background Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific implants or surgery. Implants are created either under anesthesia using silicone impressions or using 3D models from CT data. Disadvantages for patient safety are the increased risk of morbidity or radiation exposure. Materials and methods In the context of otorhinolaryngologic surgery, we present a gentle approach to treating NSP with a new image-based, contactless, and radiation-free measurement method using a 3D endoscope. The method relies on image information only and makes use of real-time capable computer vision algorithms to compute 3D information. This endoscopic method can be repeated as often as desired in the clinical course and has already proven its accuracy and robustness for robotic-assisted surgery (RAS) and surgical microscopy. We expand our method for nasal surgery, as there are additional spatial and stereoperspective challenges. Results After measuring 3 relevant parameters (NSP extension: axial, coronal, and NSP circumference) of 6 patients and comparing the results of 2 stereoendoscopes with CT data, it was shown that the image-based measurements can achieve comparable accuracies to CT data. One patient could be only partially evaluated because the NSP was larger than the endoscopic field of view. Conclusion Based on the very good measurements, we outline a therapeutic procedure which should enable the production of patient-specific NSP implants based on endoscopic data only.
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Affiliation(s)
- Jean-Claude Rosenthal
- Vision and Imaging Technologies, Fraunhofer Heinrich-Hertz-Institut HHI, Einsteinufer 37, 10587, Berlin, Germany. .,, Berlin, Germany.
| | - Eric L Wisotzky
- Vision and Imaging Technologies, Fraunhofer Heinrich-Hertz-Institut HHI, Einsteinufer 37, 10587, Berlin, Germany.,Visual Computing, Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Melanie Hobl
- HNO-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Hilsmann
- Vision and Imaging Technologies, Fraunhofer Heinrich-Hertz-Institut HHI, Einsteinufer 37, 10587, Berlin, Germany
| | - Peter Eisert
- Vision and Imaging Technologies, Fraunhofer Heinrich-Hertz-Institut HHI, Einsteinufer 37, 10587, Berlin, Germany.,Visual Computing, Humboldt Universität zu Berlin, Berlin, Germany
| | - Florian C Uecker
- HNO-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kudva A, Koshy J, Jacob JG. Oral mucosal pseudotumor - Novelty complication in patient undergoing bevacizumab therapy. Oral Oncol 2021; 122:105543. [PMID: 34592486 DOI: 10.1016/j.oraloncology.2021.105543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a manifestation of bone exposure in the maxillofacial region due to use of drugs such as bisphosphonates, anti-resorptive agents and anti-angiogenic agents. This G1- humanized monoclonal antibody neutralizes the activity of the Vascular Endothelial Growth Factor (VEGF), thus reducing the vascularity of the tumor, which in turn, results in the inhibition of its growth. This case report is of a 53-year-old man with metastatic cholangiocarcinoma who received bevacizumab therapy for the past 11 months. Delayed healing of extraction sockets, osteosclerosis, and exposed bone in the mandible with a mucosal swelling was noted a month after extractions were done. The present case reinforces recent observations that the anti-angiogenic properties of bevacizumab may present a source of osteonecrosis of the jaw. To reduce the incidences of MRONJ, it is imperative to emphasize on preventive dental care, strict oral hygiene maintenance, and regular dental follow ups.
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Affiliation(s)
- Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, 576104 Manipal, Karnataka, India.
| | - Jonathan Koshy
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, 576104 Manipal, Karnataka, India.
| | - Joanna Grace Jacob
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, 576104 Manipal, Karnataka, India
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[Endoscopic measurement of nasal septum perforations. German version]. HNO 2021; 70:206-213. [PMID: 34477908 PMCID: PMC8866253 DOI: 10.1007/s00106-021-01101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific implants or surgery. Implants are created either under anesthesia using silicone impressions or using 3D models from CT data. Disadvantages for patient safety are the increased risk of morbidity or radiation exposure. MATERIALS AND METHODS In the context of otorhinolaryngologic surgery, we present a gentle approach to treating NSP with a new image-based, contactless, and radiation-free measurement method using a 3D endoscope. The method relies on image information only and makes use of real-time capable computer vision algorithms to compute 3D information. This endoscopic method can be repeated as often as desired in the clinical course and has already proven its accuracy and robustness for robotic-assisted surgery (RAS) and surgical microscopy. We expand our method for nasal surgery, as there are additional spatial and stereoperspective challenges. RESULTS After measuring 3 relevant parameters (NSP extension: axial, coronal, and NSP circumference) of 6 patients and comparing the results of 2 stereoendoscopes with CT data, it was shown that the image-based measurements can achieve comparable accuracies to CT data. One patient could be only partially evaluated because the NSP was larger than the endoscopic field of view. CONCLUSION Based on the very good measurements, we outline a therapeutic procedure which should enable the production of patient-specific NSP implants based on endoscopic data only.
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Taira Y, Shimoji Y, Nakasone T, Arakaki Y, Nakamoto T, Kudaka W, Aoki Y. A case of nasal septal perforation caused by bevacizumab for advanced cervical cancer. J Obstet Gynaecol Res 2020; 47:833-837. [PMID: 33300217 DOI: 10.1111/jog.14589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/06/2020] [Accepted: 11/15/2020] [Indexed: 11/26/2022]
Abstract
Nasal septal perforation caused by bevacizumab is rarely reported in other cancers such as ovarian cancer and breast cancer, but it has not been reported in cervical cancer. A 48-year-old woman with a medical history of chronic allergic rhinitis was diagnosed stage 4B (T2bN1M0) cervical cancer and paclitaxel and carboplatin along with bevacizumab (triweekly) were administered. After eight courses of chemotherapy, nasal septal perforation was noted. The possibility of nasal septal perforation by bevacizumab was considered by excluding other causes. We report the first case of nasal septal perforation caused by bevacizumab for advanced cervical cancer.
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Affiliation(s)
- Yusuke Taira
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yuko Shimoji
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tadaharu Nakasone
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yoshihisa Arakaki
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Nakamoto
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Wataru Kudaka
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yoichi Aoki
- Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Rodriguez CA, Martin T, Lozano R, Gomez A, Cruz JJ. Spontaneous nasal perforation in a bevacizumab-treated patient with metastatic breast cancer. Breast J 2017; 23:745-746. [PMID: 28845572 DOI: 10.1111/tbj.12913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/18/2016] [Indexed: 11/29/2022]
Abstract
Nasal septum perforation in patients with cancer receiving systemic therapy is rare, and its association with bevacizumab use has described recently in the literature. Here, we report the case of a 34-year-old woman with hormone-sensitive, HER-2/neu negative, metastatic breast cancer who develope a nasal septum perforation during the treatment with paclitaxel and bevacizumab.
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Affiliation(s)
- Cesar A Rodriguez
- Medical Oncology Dept, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Teresa Martin
- Medical Oncology Dept, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Rebeca Lozano
- Medical Oncology Dept, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Amalia Gomez
- Medical Oncology Dept, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Juan J Cruz
- Medical Oncology Dept, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
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Nasal Septal Perforation from Bevacizumab: A Discussion of Outcomes, Management, and Pharmacovigilance. Curr Oncol Rep 2012; 14:307-10. [DOI: 10.1007/s11912-012-0236-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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A patient presenting nasal septum perforation during bevacizumab-containing chemotherapy for advanced breast cancer. Breast Cancer 2011; 18:226-30. [PMID: 21312011 DOI: 10.1007/s12282-011-0255-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
Abstract
Nasal septum perforation is a rare but described complication of the anti-angiogenetic agent bevacizumab. This is the case of a 48-year-old female breast cancer patient, who developed a nasal septum perforation during treatment with paclitaxel and bevacizumab for advanced disease. After 2 cycles the patient developed nasal irritation and occasional epistaxis; after the 4th cycle with bevacizumab the symptoms worsened to include nasal congestion, major epistaxis and rhinorrhoea. Anterior rhinoscopy revealed a large perforation involving the antero-inferior portion of the cartilaginous nasal septum surrounded by necrotic mucosa. The upper septum and the columellar strut were intact. The patient denied use of cocaine or other intranasal irritants. Bevacizumab was discontinued and with only a topical intranasal vitamin application the symptoms improved. One month later anterior rhinoscopy showed that the lesion healed and normal mucosa surrounded the previous site of perforation. The patient continued successfully with other chemotherapy regimens (gemcitabine and then vinorelbine) until irreversible progressive disease led to her death in February 2010. Thus far 8 other cases of bevacizumab-related nasal septum perforation have been published: 5 patients with colorectal cancer, 2 patients with breast cancer and 1 with ovarian cancer. Nasal septum perforation is an emerging challenge with targeted therapies and in particular with antiangiogenetic or antivascular agents. A rapid diagnosis is important and hence we recommend that patients undergoing treatment with bevacizumab and presenting with nasal symptoms (epistaxis, crusting, rhinorrhoea, nasal congestion and local pain or irritation) should undergo anterior rhinoscopy immediately.
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Mailliez A, Baldini C, Van JT, Servent V, Mallet Y, Bonneterre J. Nasal septum perforation: a side effect of bevacizumab chemotherapy in breast cancer patients. Br J Cancer 2010; 103:772-5. [PMID: 20736943 PMCID: PMC2966623 DOI: 10.1038/sj.bjc.6605828] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 06/30/2010] [Accepted: 07/04/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bevacizumab is an anti-vascular endothelial growth factor approved in association with paclitaxel or docetaxel as first line in patients (pts) with metastatic breast cancer. Rare cases of nasal septum perforations have been reported. We report our experience of nasal perforation in breast cancer pts receiving bevacizumab and chemotherapy either in the adjuvant or in the metastatic settings. METHODS Between 1 January and 31 December 2009, 70 pts received bevacizumab together with chemotherapy. All the pts who had received bevacizumab were referred to the ENT specialist. Symptoms potentially related were looked for. Side effects were graded according to CTCAE. RESULTS Five nasal septum perforations were diagnosed (5 out of 70; 7.14%). Bevacizumab dose was 15 mg kg(-1) 3 weekly. Three pts were metastatic. Bevacizumab was associated with docetaxel (100 mg m(-2) every 3 weeks) in two pts and with weekly paclitaxel in one. The last two pts received bevacizumab in combination with anthracyclin and then taxanes in the adjuvant setting. In these two cases, nasal septum perforation occurred at the time of docetaxel treatment. CONCLUSION A high incidence of nasal septum perforation has been shown in pts with breast cancer receiving bevacizumab together with chemotherapy. Several mechanisms could be involved (mucositis, delayed tissue repair, antiangiogenic action of taxanes).
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Affiliation(s)
- A Mailliez
- Breast Cancer Department, Centre Oscar Lambret, 3 rue F Combemale, Lille 59000, France.
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