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Review
. 2022 Mar 25;14(7):1666.
doi: 10.3390/cancers14071666.

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

Gianluca Gazzaniga  1 , Federica Villa  2   3 , Federica Tosi  3 , Elio Gregory Pizzutilo  2   3 , Stefano Colla  1 , Stefano D'Onghia  1 , Giusy Di Sanza  1 , Giulia Fornasier  1 , Michele Gringeri  1 , Maria Victoria Lucatelli  1 , Giulia Mosini  1 , Arianna Pani  2   4 , Salvatore Siena  2   3 , Francesco Scaglione  2   4 , Andrea Sartore-Bianchi  2   3
Affiliations
Review

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

Gianluca Gazzaniga et al. Cancers (Basel). .

Abstract

Pneumatosis intestinalis (PI) is a rare condition due to the presence of gas within the bowel wall; it is mainly caused by endoscopic procedures, infections and other gastrointestinal diseases. Oncological therapies have been reported to be a cause of PI as well, but their role is not clearly defined. This systematic review investigates the concurrency of PI and antitumor therapy in cancer patients, considering both solid tumors and onco-hematological ones. We performed a literature review of PubMed, Embase and the Web of Science up to September 2021 according to the PRISMA guidelines. A total of 62 papers reporting 88 different episodes were included. PI was mainly reported with targeted therapies (sunitinib and bevacizumab above all) within the first 12 weeks of treatment. This adverse event mostly occurred in the metastatic setting, but in 10 cases, it also occurred also in the neoadjuvant and adjuvant setting. PI was mostly localized in the large intestine, being fatal in 11 cases, while in the remaining cases, symptoms were usually mild, or even absent. A significant risk of PI reoccurrence after drug reintroduction was also reported (6/18 patients), with no fatal outcomes. Potential pharmacological mechanisms underlying PI pathogenesis are also discussed. In conclusion, although uncommonly, PI can occur during oncological therapies and may lead to life-threatening complications; therefore, consideration of its occurrence among other adverse events is warranted in the presence of clinical suspicion.

Keywords: adverse drug events; chemotherapy; hematology; immunotherapy; molecular targeted therapy; oncology; pneumatosis intestinalis.

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Conflict of interest statement

S.S. is an advisory board member for Amgen, Bayer, BMS, CheckmAb, Daiichi-Sankyo, Guardant Health, Merck, Novartis, Roche-Genentech and Seattle Genetics. A.S.-B. is an advisory board member for Amgen, Bayer, Novartis, Sanofi and Servier. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Radiological findings in a 79-year-old patient diagnosed at our institution with a gastrointestinal stromal tumor (GIST) and symptoms of abdominal pain. CT scan shows the presence of gas in the gastric wall at the greater curvature and in left intrahepatic portal system (black arrows). (Courtesy of Prof. Angelo Vanzulli, Radiology Department, Grande Ospedale Metropolitano Niguarda, Milano, Italy).
Figure 2
Figure 2
PRISMA Flow.
Figure 3
Figure 3
Anticancer therapies most commonly reported in published cases of cancer patients with PI (Panel (A), only reported if occurrence was found in at least 3 patients) and number of cases grouped according to pharmacological class (Panel (B)) 5FU, fluorouracil; mAb monoclonal antibodies.
Figure 4
Figure 4
Time (in weeks) from treatment start to PI onset.
Figure 5
Figure 5
Overview of pneumatosis intestinalis management.
See this image and copyright information in PMC

References

    1. Sachse R.E., Burke G.W., Jonas M., Milgrom M., Miller J. Benign pneumatosis intestinalis with subcutaneous emphysema in a liver transplant recipient. Am. J. Gastroenterol. 1990;85:876–879. - PubMed
    1. Heng Y., Schuffler M.D., Haggitt R.C., Rohrmann C.A. Pneumatosis intestinalis: A review. Am. J. Gastroenterol. 1995;90:1747–1758. - PubMed
    1. Ho L.M., Paulson E.K., Thompson W.M. Pneumatosis intestinalis in the adult: Benign to life-threatening causes. AJR Am. J. Roentgenol. 2007;188:1604–1613. doi: 10.2214/AJR.06.1309. - DOI - PubMed
    1. Pieterse A.S., Leong A.S., Rowland R. The mucosal changes and pathogenesis of pneumatosis cystoides intestinalis. Hum. Pathol. 1985;16:683–688. doi: 10.1016/S0046-8177(85)80152-0. - DOI - PubMed
    1. Yale C.E., Balish E., Wu J.P. The bacterial etiology of pneumatosis cystoides intestinalis. Arch. Surg. 1974;109:89–94. doi: 10.1001/archsurg.1974.01360010067017. - DOI - PubMed