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

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.