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Chaudhuri AA, Chen JJ, Carter JN, et al. Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab. Cureus. 2016;8(4):e578doi: 10.7759/cureus.578.
Chaudhuri, A. A., Chen, J. J., Carter, J. N., Binkley, M. S., Kumar, K. A., Dudley, S. A., Sung, A. W., & Loo, B. W. (2016). Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab. Cureus, 8(4), e578. https://doi.org/10.7759/cureus.578
Chaudhuri, Aadel A, et al. "Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab." Cureus vol. 8,4 (2016): e578. doi: https://doi.org/10.7759/cureus.578
Chaudhuri AA, Chen JJ, Carter JN, Binkley MS, Kumar KA, Dudley SA, Sung AW, Loo BW. Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab. Cureus. 2016 Apr 19;8(4):e578. doi: 10.7759/cureus.578. PMID: 27226939; PMCID: PMC4873316.
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Cureus. 2016 Apr 19;8(4):e578. doi: 10.7759/cureus.578.

Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab.

Cureus

Aadel A Chaudhuri, Jie Jane Chen, Justin N Carter, Michael S Binkley, Kiran A Kumar, Sara A Dudley, Arthur W Sung, Billy W Loo

Affiliations

  1. Department of Radiation Oncology, Stanford University School of Medicine.
  2. Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine.
  3. Department of Radiation Oncology, Stanford University School of Medicine ; Stanford Cancer Institute, Stanford University School of Medicine.

PMID: 27226939 PMCID: PMC4873316 DOI: 10.7759/cureus.578

Abstract

We present the case of a 63-year-old woman with limited metastatic colorectal cancer to the lungs and liver treated with FOLFIRI-bevacizumab, followed by consolidative hypofractionated radiotherapy to right paratracheal metastatic lymphadenopathy. We treated the right paratracheal site with 60 Gy in 15 fractions (70 Gy equivalent dose in 2 Gy fractions). The patient tolerated the treatment well, and six months later started a five-month course of FOLFIRI-bevacizumab for new metastatic disease. She presented to our clinic six months after completing this, complaining of productive cough with scant hemoptysis, and was found to have localized tracheal wall breakdown and diverticulum in the region of prior high-dose radiation therapy, threatening to progress to catastrophic tracheovascular fistula. This was successfully repaired surgically after a lack of response to conservative measures. We urge caution in treating patients with vascular endothelial growth factor (VEGF) inhibitors in the setting of hypofractionated radiotherapy involving the mucosa of tubular organs, even when these treatments are separated by months. Though data is limited as to the impact of sequence, this may be particularly an issue when VEGF inhibitors follow prior radiotherapy.

Keywords: bevacizumab; hypofractionated conformal radiotherapy; oligometastatic cancer; tracheal diverticulum; vegf inhibitor; volumetric modulated arc therapy (vmat)

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