Two Cases of Pneumatosis Intestinalis during Cetuximab Therapy for Advanced Head and Neck Cancer

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

Simple Summary

Anticancer treatments commonly cause adverse events (AE). Among others, pneumatosis intestinalis (PI) is reported to be infrequent, though it can lead to severe consequences. The aim of our systematic review was to investigate the concurrency of PI and oncological therapy exposure; moreover, we defined the characteristics of patients and the primarily involved tumor types. We analyzed 88 different episodes of PI. The median time of onset was 6 weeks and oncological patients with respiratory system cancers and those treated with targeted therapies appeared be at higher risk. Symptoms were frequently mild to absent; nevertheless, life-threatening complications were reported. Therefore, this AE, although uncommon, should be considered in the case of specific symptoms. Potential pharmacological mechanisms of anticancer drugs in inducing PI are also discussed.

Abstract

Pneumatosis intestinalis (PI) is a rare condition due to the presence of gas within the bowel wall; it is mainly caused by endoscopic procedures, infections and other gastrointestinal diseases. Oncological therapies have been reported to be a cause of PI as well, but their role is not clearly defined. This systematic review investigates the concurrency of PI and antitumor therapy in cancer patients, considering both solid tumors and onco-hematological ones. We performed a literature review of PubMed, Embase and the Web of Science up to September 2021 according to the PRISMA guidelines. A total of 62 papers reporting 88 different episodes were included. PI was mainly reported with targeted therapies (sunitinib and bevacizumab above all) within the first 12 weeks of treatment. This adverse event mostly occurred in the metastatic setting, but in 10 cases, it also occurred also in the neoadjuvant and adjuvant setting. PI was mostly localized in the large intestine, being fatal in 11 cases, while in the remaining cases, symptoms were usually mild, or even absent. A significant risk of PI reoccurrence after drug reintroduction was also reported (6/18 patients), with no fatal outcomes. Potential pharmacological mechanisms underlying PI pathogenesis are also discussed. In conclusion, although uncommonly, PI can occur during oncological therapies and may lead to life-threatening complications; therefore, consideration of its occurrence among other adverse events is warranted in the presence of clinical suspicion.

Oesophageal pneumatosis in a case of bowel ischaemia

Pneumatosis intestinalis (PI) is a condition in which cystic collections of gas develop within the gastrointestinal wall, forming submucosal or subserosal "bubbles". The radiologic manifestations are often dramatic and most notably are associated with life-threatening bowel ischaemia. PI may occur as a primary type but is usually secondary in nature, attributable to a wide spectrum of causes (benign and fulminant), ranging from immunosuppression to bowel infarction. Herein, we report a case of massive and extensive PI in a patient with small bowel ischaemia, having both benign and serious clinical origins.

Molecular Targeted Therapy in Modern Oncology: Imaging Assessment of Treatment Response and Toxicities

Oncology is a rapidly evolving field with a shift toward personalized cancer treatment. The use of therapies targeted to the molecular features of individual tumors and the tumor microenvironment has become much more common. In this review, anti-angiogenic and other molecular targeted therapies are discussed, with a focus on typical and atypical response patterns and imaging manifestations of drug toxicities.

Pneumatosis intestinalis in oncologic patients: when should the radiologist not be afraid?

Pneumatosis intestinalis (PI) is a term used to describe the presence of submucosal and subserosal gas in the gastrointestinal tract. It can occur as a primary disease or, more commonly, secondary to various other causes ranging from benign conditions to fulminant diseases. We present four cases of benign PI in patients being treated for various types of cancer. They had no abdominal symptoms, the physical examination was normal and PI was an isolated incidental CT finding in the absence of other signs of bowel wall distress. A conservative non-surgical approach was advocated and follow-up imaging documented the resolution of PI. The radiologist should recognize this condition in order to help the oncologist to interpret its clinical significance and avoid unnecessary surgical procedures.