Abstract
Glioblastoma is one of the most aggressive brain tumors in adults. The standard treatment is radiotherapy and chemotherapy based on the Stupp regimen after maximal safe resection. One effective chemotherapeutic drug is bevacizumab, which can prolong progression-free survival in glioblastoma patients but not overall survival. Adverse events of bevacizumab include hypertension, proteinuria, delayed wound healing, bleeding of the nose and gums, and thromboembolism resulting in gastrointestinal perforation. Herein, we describe an autopsy case of a patient with glioblastoma who died from non-occlusive mesenteric ischemia that was presumably caused by bevacizumab.
Similar content being viewed by others
Data availability
Not applicable.
Code availability
Not applicable.
References
Diaz RJ, Ali S, Qadir MG, De La Fuente MI, Ivan ME, Komotar RJ (2017) The role of bevacizumab in the treatment of glioblastoma. J Neurooncol 133:455–467. https://doi.org/10.1007/s11060-017-2477-x
Hirner A, Haring R, Hofmeister M (1987) Acute mesenteric vascular occlusions. Chirurg 58:577–584
Gilbert MR, Dignam JJ, Armstrong TS, Wefel JS, Blumenthal DT, Vogelbaum MA, Colman H, Chakravarti A, Pugh S, Won M, Jeraj R, Brown PD, Jaeckle KA, Schiff D, Stieber VW, Brachman DG, Werner-Wasik M, Tremont-Lukats IW, Sulman EP, Aldape KD, Curran WJ Jr, Mehta MP (2014) A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med 370:699–708. https://doi.org/10.1056/NEJMoa1308573
Gonzalez J, Kumar AJ, Conrad CA, Levin VA (2007) Effect of bevacizumab on radiation necrosis of the brain. Int J Radiat Oncol Biol Phys 67:323–326. https://doi.org/10.1016/j.ijrobp.2006.10.010
Kamba T, Tam BY, Hashizume H, Haskell A, Sennino B, Mancuso MR, Norberg SM, O’Brien SM, Davis RB, Gowen LC, Anderson KD, Thurston G, Joho S, Springer ML, Kuo CJ, McDonald DM (2006) VEGF-dependent plasticity of fenestrated capillaries in the normal adult microvasculature. Am J Physiol Heart Circ Physiol 290:H560-576. https://doi.org/10.1152/ajpheart.00133.2005
Matsuzawa M, Harada K, Hosomura N, Amemiya H, Ando N, Inozume T, Kawamura T, Shibagaki N, Shimada S (2015) Non-occlusive mesenteric ischemia after chemotherapy for metastatic melanoma. J Dermatol 42:105–106. https://doi.org/10.1111/1346-8138.12734
Miyatake S, Furuse M, Kawabata S, Maruyama T, Kumabe T, Kuroiwa T, Ono K (2013) Bevacizumab treatment of symptomatic pseudoprogression after boron neutron capture therapy for recurrent malignant gliomas. Report of 2 cases. Neuro Oncol 15:650–655. https://doi.org/10.1093/neuonc/not020
Norden AD, Drappatz J, Ciampa AS, Doherty L, LaFrankie DC, Kesari S, Wen PY (2009) Colon perforation during antiangiogenic therapy for malignant glioma. Neuro Oncol 11:92–95. https://doi.org/10.1215/15228517-2008-071
Perez-Garcia C, de Miguel CE, Fernandez Gonzalo A, Malfaz C, Martin Pinacho JJ, Fernandez Alvarez C, Herranz Perez R (2018) Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery. Br J Radiol 91:20170492. https://doi.org/10.1259/bjr.20170492
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for R, Treatment of Cancer Brain T, Radiotherapy G, National Cancer Institute of Canada Clinical Trials G (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. https://doi.org/10.1056/NEJMoa043330
Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P (2002) Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol 12:1179–1187. https://doi.org/10.1007/s00330-001-1220-2
Wang Y, Fei D, Vanderlaan M, Song A (2004) Biological activity of bevacizumab, a humanized anti-VEGF antibody in vitro. Angiogenesis 7:335–345. https://doi.org/10.1007/s10456-004-8272-2
Wirsching HG, Galanis E, Weller M (2016) Glioblastoma. Handb Clin Neurol 134:381–397. https://doi.org/10.1016/B978-0-12-802997-8.00023-2
Woodhams R, Nishimaki H, Fujii K, Kakita S, Hayakawa K (2010) Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images. Eur J Radiol 76:96–102. https://doi.org/10.1016/j.ejrad.2009.05.012
Yukaya T, Saeki H, Taketani K, Ando K, Ida S, Kimura Y, Oki E, Yasuda M, Morita M, Shirabe K, Maehara Y (2014) Clinical outcomes and prognostic factors after surgery for non-occlusive mesenteric ischemia: a multicenter study. J Gastrointest Surg 18:1642–1647. https://doi.org/10.1007/s11605-014-2579-0
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics approval
Not applicable.
Consent to participate and publish
Written informed consent was obtained from the patient’s family.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Tumor - Glioma
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Oikawa, N., Kinoshita, M., Yamamura, M. et al. Non-occlusive mesenteric ischemia during bevacizumab treatment for glioblastoma: a case report. Acta Neurochir 164, 2767–2771 (2022). https://doi.org/10.1007/s00701-022-05328-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-022-05328-1