Abstract
BACKGROUND: Gastrointestinal tumors are among the most common and deadly cancers globally, with radiotherapy and bevacizumab being key treatment strategies. Radiotherapy uses high-energy radiation to target DNA, reducing tumor size and alleviating symptoms. Bevacizumab, a targeted therapy, inhibits angiogenesis and tumor growth, particularly in advanced gastrointestinal cancers. However, both treatments can cause adverse gastrointestinal effects, such as intestinal mucosal damage and perforation. While research on the risk of intestinal perforation has grown, the underlying mechanisms remain underexplored. This study aims to compare the incidence of intestinal perforation and survival rates in patients treated with radiotherapy combined with bevacizumab vs bevacizumab alone. AIM: To investigate the effect of radiotherapy on the risk of intestinal perforation in patients with colon cancer treated with bevacizumab. METHODS: A total of 70 patients diagnosed with gastrointestinal malignancies admitted to our hospital from January 2023 to December 2024 were selected as research subjects. According to different treatment methods, 70 patients were divided into the bevacizumab only group (receiving bevacizumab treatment) and the bevacizumab + radiotherapy group (receiving radiotherapy combined with bevacizumab treatment), with 35 cases in each group. The two groups were compared in terms of clinical efficacy, incidence of intestinal perforation, serum tumor marker levels, overall survival and progression-free survival, levels of angiogenic factors, and adverse reactions. RESULTS: Compared with the group treated with bevacizumab alone, the group treated with bevacizumab plus radiotherapy showed significant improvements in effective rate, overall survival, and progression-free survival (P < 0.05); the probability of intestinal perforation in the bevacizumab + radiotherapy group was 13.33%, while the probability of intestinal perforation in the bevacizumab group was 0. There was a statistically significant difference in the incidence of intestinal perforation between the two groups (P = 0.039). Following treatment, the levels of carbohydrate antigen (CA) 125, CA199, and CA153 in patients were significantly reduced (P < 0.05). CONCLUSION: Radiation therapy may increase the risk of intestinal perforation in colon cancer patients receiving bevacizumab treatment. In clinical applications, the risks of combined use of radiotherapy and bevacizumab should be fully considered and personalized treatment plans should be formulated.