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Case Report Open Access

Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report

  • Authors:
    • Qiang Jia
    • Yun-Long Zhou
    • Lan-Ying Duan
    • Hui-Chao Li
    • Gaowu Hu
  • View Affiliations / Copyright

    Affiliations: Department of Oncology, Jiangyou Second People's Hospital, Jiangyou, Mianyang, Sichuan 621701, P.R. China
    Copyright: © Jia et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 595
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    Published online on: October 15, 2025
       https://doi.org/10.3892/ol.2025.15341
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Abstract

The combination of bevacizumab and chemotherapy regimens has been widely recognized by international authoritative guidelines. However, although this treatment regimen has demonstrated a definite antitumor effect, its drug safety issues still require clinical attention. Notably, among the adverse reactions related to bevacizumab, esophageal perforation, as a serious complication that may endanger lives, has rarely been described in the literature in the field of lung cancer treatment. The present report describes a case of a rare complication of esophageal perforation that occurred during the treatment process in a patient with advanced lung adenocarcinoma who received bevacizumab combined with radiotherapy and chemotherapy. By systematically reviewing the clinical features, imaging evolution and treatment process of the present case, and assessing the occurrence mechanism, high‑risk factors and treatment measures of esophageal perforation caused by bevacizumab in patients with lung cancer, the present study suggests that underlying gastrointestinal diseases can damage the esophageal mucosa, and that the combination of radiotherapy and chemotherapy can aggravate the damage and produce synergistic toxicity with the anti‑angiogenic effect of bevacizumab to induce esophageal perforation. In conclusion, esophageal perforation is a rare adverse reaction and the risk of its occurrence is markedly increased when bevacizumab is combined with radiotherapy and chemotherapy. Therefore, high‑risk factors need to be strictly evaluated before its use to optimize treatment decisions and enhance the ability to prevent and control serious complications.
View Figures

Figure 1

Isodose curve diagram showing the
radiation dose distribution in the patient. Different colored
curves each represent isodose lines, with doses measured in cGy;
their specific values are as indicated in the ‘Isovalues (cGy)’
legend, which are 4000.0, 3500.0, 3000.0, 2500.0 and 2000.0
respectively. The yellow-shaded region in the diagram indicates the
target volume receiving radiation. cGY, centigray.

Figure 2

Clinical examination images. CT images
of the patient from October 2024 (left) and November 2024 (right),
respectively. By comparing these two images, it can be seen that
there is no significant progressive change in the shape, size or
other aspects of the mass-like shadow at the stump of the right
lung after surgery (marked with a red circle); meanwhile, through
observation of the CT images from October and November, the
phenomenon of lymphadenopathy in the mediastinal region can be
clearly observed (marked with a yellow circle).

Figure 3

Esophagography performed with iohexol.
The esophagus is not well visualized, with some of the contrast
agent entering the trachea and resulting in partial opacification
of the trachea. The image clearly shows a communication between the
esophagus and the trachea (marked by the red arrow), thus
confirming the diagnosis of tracheoesophageal fistula.

Figure 4

Gastroscopy. Gastroscopic image
showing a fistula opening (marked by the yellow arrow) with a size
of ~0.5×0.5 cm at the esophageal site, 35 cm from the incisors.
This image was captured using narrow-band imaging technology in the
A3 electronic staining mode, with an optical magnification of 1.0×,
which clearly displays the fistula opening and the fine structure
of the surrounding mucosal tissue.

Figure 5

Fluoroscopic image of the esophagus. A
stent is visible in the middle segment of the esophagus. The
contrast agent flows relatively smoothly downward through the
stented area (marked by the red arrow), which demonstrates that the
esophagus remains patent after stent placement.
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Copy and paste a formatted citation
Spandidos Publications style
Jia Q, Zhou Y, Duan L, Li H and Hu G: Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report. Oncol Lett 30: 595, 2025.
APA
Jia, Q., Zhou, Y., Duan, L., Li, H., & Hu, G. (2025). Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report. Oncology Letters, 30, 595. https://doi.org/10.3892/ol.2025.15341
MLA
Jia, Q., Zhou, Y., Duan, L., Li, H., Hu, G."Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report". Oncology Letters 30.6 (2025): 595.
Chicago
Jia, Q., Zhou, Y., Duan, L., Li, H., Hu, G."Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report". Oncology Letters 30, no. 6 (2025): 595. https://doi.org/10.3892/ol.2025.15341
Copy and paste a formatted citation
x
Spandidos Publications style
Jia Q, Zhou Y, Duan L, Li H and Hu G: Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report. Oncol Lett 30: 595, 2025.
APA
Jia, Q., Zhou, Y., Duan, L., Li, H., & Hu, G. (2025). Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report. Oncology Letters, 30, 595. https://doi.org/10.3892/ol.2025.15341
MLA
Jia, Q., Zhou, Y., Duan, L., Li, H., Hu, G."Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report". Oncology Letters 30.6 (2025): 595.
Chicago
Jia, Q., Zhou, Y., Duan, L., Li, H., Hu, G."Esophageal perforation in a patient with lung cancer after administration of bevacizumab combined with radiotherapy and chemotherapy: A case report". Oncology Letters 30, no. 6 (2025): 595. https://doi.org/10.3892/ol.2025.15341
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