Gastro-pleuro-pericardial fistula following combined radiation and chemotherapy for lung metastases from renal cell carcinoma: report of a case

Neri, Alessandro; Lambert, Youdel Ramon; Marrelli, Daniele; Mare, Giulio Di; Mastrogiacomo, Doralba; Corso, Giovanni; Volterrani, Luca; Roviello, Franco

doi:10.1007/s00595-012-0475-3

Cited by 17 publications

(13 citation statements)

References 20 publications

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“…Although there are reports of radiation dermatitis, bowel toxicities, and pneumonitis, TKIs are generally well tolerated when delivered with radiation. 2,5,8,18,29 However, the safety and efficacy of concur-rent therapy remains particularly unknown despite a growing utilization of SRS in the mRCC patient population. Several investigators have postulated that TKIs offer an added benefit when delivered concurrently with radiation, extrapolating from preclinical models and the radiobiology of SRS.…”

Section: Discussionmentioning

confidence: 99%

Spine stereotactic radiosurgery with concurrent tyrosine kinase inhibitors for metastatic renal cell carcinoma

Miller

Balagamwala

Angelov

et al. 2016

SPI

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OBJECT Systemic control of metastatic renal cell carcinoma (mRCC) has substantially improved with the development of VEGF, mTOR, and checkpoint inhibitors. The current first-line standard of care is a VEGF tyrosine kinase inhibitor (TKI). In preclinical models, TKIs potentiate the response to radiotherapy. Such improved efficacy may prolong the time to salvage therapies, including whole-brain radiotherapy or second-line systemic therapy. As the prevalence of mRCC has increased, the utilization of spine stereotactic radiosurgery (SRS) has also increased. However, clinical outcomes following concurrent treatment with SRS and TKIs remain largely undefined. The purpose of this investigation was to determine the safety and efficacy of TKIs when delivered concurrently with SRS. The authors hypothesized that first-line TKIs delivered concurrently with SRS significantly increase local control compared with SRS alone or TKIs alone, without increased toxicity. METHODS A retrospective cohort study of patients undergoing spine SRS for mRCC was conducted. Patients undergoing SRS were divided into 4 cohorts: those receiving concurrent first-line TKI therapy (A), systemic therapy–naïve patients (B), and patients who were undergoing SRS with (C) or without (D) concurrent TKI treatment after failure of first-line therapy. A negative control cohort (E) was also included, consisting of patients with spinal metastases managed with TKIs alone. The primary outcome was 12-month local failure, defined as any in-field radiographic progression. Multivariate competing risks regression was used to determine the independent effect of concurrent first-line TKI therapy upon local failure. RESULTS One hundred patients who underwent 151 spine SRS treatments (232 vertebral levels) were included. At the time of SRS, 46% were receiving concurrent TKI therapy. In each SRS cohort, the median prescription dose was 16 Gy in 1 fraction. Patients in Cohort A had the highest burden of epidural disease (96%, p < 0.01). At 12 months, the cumulative incidence of local failure was 4% in Cohort A, compared with 19%–27% in Cohorts B–D and 57% in Cohort E (p < 0.01). Multivariate competing risks regression demonstrated that concurrent first-line TKI treatment (Cohort A) was independently associated with a local control benefit (HR 0.21, p = 0.04). In contrast, patients treated with TKIs alone (Cohort E) experienced an increased rate of local failure (HR 2.43, p = 0.03). No toxicities of Grade 3 or greater occurred following SRS with concurrent TKI treatment, and the incidence of post-SRS vertebral fracture (overall 21%) and pain flare (overall 17%) were similar across cohorts. CONCLUSIONS The prognosis for patients with mRCC has significantly improved with TKIs. The present investigation suggests a local control benefit with the addition of concurrent first-line TKI therapy to spine SRS. These results have implications in the oligometastatic setting and support a body of preclinical radiobiological research.

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Section: Discussionmentioning

confidence: 99%

Spine stereotactic radiosurgery with concurrent tyrosine kinase inhibitors for metastatic renal cell carcinoma

Miller

Balagamwala

Angelov

et al. 2016

SPI

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“…They are very uncommon and can occur as a consequence of pulmonary surgeries (resection), intrathoracic gastric perforation in a hiatal hernia, a perforated malignant gastric ulcer at the fundus, extension of a subphrenic abscess with gastric perforation, gastric bypass procedures, or malignancy (Ewing sarcoma) [12-15]. It has also been reported as a complication post-treatment with radiotherapy and chemotherapy [15-16]. They are difficult to manage conservatively and often require gastrectomy and thoracotomy in debilitated patients.…”

Section: Discussionmentioning

confidence: 99%

Gastropleural Fistula: A Rare Complication of a Common Procedure

Iqbal

Zhi

Masud

et al. 2019

Cureus

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Weight loss surgeries are evident to be highly beneficial in patients with morbid obesity (body mass index (BMI) ≥40.0 kg/m 2 ) and severe obesity (BMI between 35.0 and 39.9 kg/m 2 with co-morbidities). While this results in significant mortality benefit, there is always the possible risk of postsurgical complications. Gastrobronchial and gastropleural fistulas are two rare, post-operative pulmonary complications associated with these surgeries. Our patient is a 54-year-old female who underwent a biliopancreatic diversion with a duodenal switch. A few weeks later, she started developing a cough, fever, and shortness of breath. Computed tomography (CT) chest showed the presence of a loculated right sided hydropneumothorax. A gastrointestinal fluoroscopic contrast study performed showed a large fistula originating from the distal end of the stomach and ending towards the right pleural cavity. The fistula was successfully closed with the endoscopic fulguration of fistulous opening with argon beam coagulation and orthoscopic clipping, resulting in complete obliteration of the fistula tract. The right-sided hydropneumothorax was initially treated conservatively with antibiotics and chest tube drains followed by video-assisted thoracoscopic decortication with chest tube placement. Gastropleural fistula formation is rare but is nonetheless a serious postoperative complication of bariatric procedures and mimics pneumonia clinically. It is, therefore, essential to obtain detailed imaging work-up to rule out fistula formation, which, in turn, can be timely treated without causing further devastating results to the patient.

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“…The reported cases of GPF were mostly related to trauma [12], [13], chronic gastrointestinal herniation in the thoracic cavity as in diaphragmatic and hiatus hernia [14], [15] and malignancy (ovarian carcinoma [16], ewing’s sarcoma [17] and renal cell carcinoma [18]). …”

Section: Discussionmentioning

confidence: 99%

Gastropleural fistula after single anastomosis gastric bypass. A case report and review of the literature

Al-Shurafa

Alghamdi

Albenmousa

et al. 2017

International Journal of Surgery Case Reports

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Gastro-pleuro-pericardial fistula following combined radiation and chemotherapy for lung metastases from renal cell carcinoma: report of a case

Cited by 17 publications

References 20 publications

Spine stereotactic radiosurgery with concurrent tyrosine kinase inhibitors for metastatic renal cell carcinoma

Spine stereotactic radiosurgery with concurrent tyrosine kinase inhibitors for metastatic renal cell carcinoma

Gastropleural Fistula: A Rare Complication of a Common Procedure

Gastropleural fistula after single anastomosis gastric bypass. A case report and review of the literature

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