Clinical Image
Cavitating Lung Cancer as Response to Bevacizumab Treatment
Cavitación de adenocarcinoma de pulmón como respuesta al tratamiento con bevacizumab
Lucía Fernández Rodríguez
, Alicia Linares Beltrán, Isabel Torres Sánchez
Corresponding author
Sección de Imagen Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
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Observamos una masa sólida de 6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm de bordes infiltrativos, con necrosis en su interior y realce periférico en segmento posterior del LSD adyacente a pleura posterior. B y D) Cortes axiales de TC en ventana de mediastino y de pulmón. Apreciamos otra lesión sólida en el LII adyacente a pleura diafragmática, de contornos infiltrativos, con menor necrosis. E y F) Cortes axiales de TC en ventana de pulmón, a los 6 meses del inicio del tratamiento con bevacizumab. En E vemos la lesión del LSD de mayor tamaño, cavitada y sin componente sólido, y en F la tumoración sólida del LII de menor tamaño y atenuación que en -B y -D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Fernández-Rodríguez, Alicia Linares-Beltrán, Isabel Torres-Sánchez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Fernández-Rodríguez" ] 1 => array:2 [ "nombre" => "Alicia" "apellidos" => "Linares-Beltrán" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Torres-Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212916301720" "doi" => "10.1016/j.arbr.2016.07.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301720?idApp=UINPBA00003Z" ] ] 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"tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "533" "paginaFinal" => "534" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seudoquilotórax sin engrosamiento pleural asociado a artritis reumatoide" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 900 "Tamanyo" => 65608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT image showing pleural effusion with no signs of pleural thickening.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Zamora Molina, Guillermo Moreno Redondo, Alejandro Maestro Borbolla" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Zamora Molina" ] 1 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Moreno Redondo" ] 2 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Maestro Borbolla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616300035" "doi" => "10.1016/j.arbres.2016.02.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616300035?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301781?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301781/v2_201609300109/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212916301756" "issn" => "15792129" "doi" => 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true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 729 "Ancho" => 1700 "Tamanyo" => 162769 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal reconstruction of chest CT (pulmonary parenchymal window) showing multiple nodules in both lungs (white asterisks). 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(B) Coronal reconstruction of chest CT (pulmonary parenchyma window, more anterior plane than image A), showing anterior loculated pneumothorax in right hemithorax (asterisk).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Gemma María Muñoz-Molina, Paola Arrieta" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Gemma María" "apellidos" => "Muñoz-Molina" ] 2 => array:2 [ "nombre" => "Paola" "apellidos" => "Arrieta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289615004834" "doi" => "10.1016/j.arbres.2015.11.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615004834?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301756?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301756/v2_201609300109/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Cavitating Lung Cancer as Response to Bevacizumab Treatment" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "532" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucía Fernández Rodríguez, Alicia Linares Beltrán, Isabel Torres Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Lucía" "apellidos" => "Fernández Rodríguez" "email" => array:1 [ 0 => "luciafernanro@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Alicia" "apellidos" => "Linares Beltrán" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Torres Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Imagen Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cavitación de adenocarcinoma de pulmón como respuesta al tratamiento con bevacizumab" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr1ad.jpeg" ] 1 => array:1 [ "imagen" => "gr1ef.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and C) Axial CT slices in the mediastinal and lung windows, respectively. A solid mass 6<span class="elsevierStyleHsp" style=""></span>cm×4<span class="elsevierStyleHsp" style=""></span>cm with infiltrative margins, containing necrosis, and peripheral enhancement in the posterior segment of the RUL adjacent to the posterior pleura. (B and D) Axial CT slices in the mediastinal and lung windows. Another solid lesion is seen in the LLL, adjacent to the diaphragmatic pleura, with infiltrative contours and less necrosis. (E and F) Axial CT slices in lung window, 6 months after starting bevacizumab treatment. In E, the RUL lesion can be seen to be larger, cavitated and with no solid component, and in F, the solid tumor in the LLL is smaller with lower attenuation than in images B and D.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 57-year-old woman, former smoker, consulted due to irritative cough. Chest radiograph showed a right paratracheal mass and a nodule in the left lower lobe (LLL) with characteristics of malignancy. CT revealed a solid, necrotized mass with peripheral enhancement in the right upper lobe (RUL) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and C), and another similar subpleural lesion in the LLL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and D), and pathologically enlarged hilar lymph nodes. All lesions were observed on PET.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">FNAB was performed in both lesions, and the pathology report found EGFR-mutation negative and ALK-mutation negative lung adenocarcinoma. Treatment was started with taxol–carboplatin–bevacizumab (antiangiogenic), followed by maintenance bevacizumab.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the follow-up CT, the RUL lesion had increased in size, with cavitation and reduced solid component (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). The LLL tumor and lymphadenopathy had reduced in size and attenuation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F).</p><p id="par0020" class="elsevierStylePara elsevierViewall">There have been far-reaching changes in the treatment of advanced lung cancer, with the introduction of molecular targets, and immunological and antiangiogenic therapy that have different mechanisms of action and patterns of response from those of conventional chemotherapy. The effects of antiangiogenics include not only change in size, but also the appearance of cavitation (20%), considered a criterion for good treatment response. Although the overall size of the lesions increases, cavitation and reduced solid component are considered a positive response.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Rodríguez L, Linares-Beltrán A, Torres-Sánchez, I. Cavitación de adenocarcinoma de pulmón como respuesta al tratamiento con bevacizumab. Arch Bronconeumol. 2016;52:531–532.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr1ad.jpeg" ] 1 => array:1 [ "imagen" => "gr1ef.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and C) Axial CT slices in the mediastinal and lung windows, respectively. A solid mass 6<span class="elsevierStyleHsp" style=""></span>cm×4<span class="elsevierStyleHsp" style=""></span>cm with infiltrative margins, containing necrosis, and peripheral enhancement in the posterior segment of the RUL adjacent to the posterior pleura. (B and D) Axial CT slices in the mediastinal and lung windows. Another solid lesion is seen in the LLL, adjacent to the diaphragmatic pleura, with infiltrative contours and less necrosis. (E and F) Axial CT slices in lung window, 6 months after starting bevacizumab treatment. In E, the RUL lesion can be seen to be larger, cavitated and with no solid component, and in F, the solid tumor in the LLL is smaller with lower attenuation than in images B and D.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones para el diagnóstico radiológico y la valoración de la respuesta terapéutica en el cáncer de pulmón. Consenso nacional de la Sociedad Española de Radiología Médica y la Sociedad Española de Oncología Médica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Ferreirós" 1 => "B. Cabeza" 2 => "A. Gayete" 3 => "M. Sánchez" 4 => "M.I. Torres" 5 => "M. Cobo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rx.2014.10.002" "Revista" => array:6 [ "tituloSerie" => "Radiologia" "fecha" => "2015" "volumen" => "57" "paginaInicial" => "66" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25530188" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301720/v2_201609300109/en/main.assets" "Apartado" => array:4 [ "identificador" => "21342" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000010/v2_201609300109/S1579212916301720/v2_201609300109/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301720?idApp=UINPBA00003Z" ]
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