Impact of Bevacizumab treatment intervals on surgical interventions in pediatric neuro-oncology

Bevacizumab (BVZ) is widely used in patients with central nervous system (CNS) tumors. Due to its potential to impair wound healing, a minimum interval of 28 days between BVZ administration and surgery - both before and after the procedure - is generally recommended. However, strict adherence to this interval is often challenging in clinical practice, particularly when urgent oncologic treatment or time-sensitive surgical interventions are required.

Pediatric patients with a CNS tumor receiving intravenous BVZ from January 2005 to December 2022 treated at the Medical University of Vienna were retrospectively analyzed for surgical complications.

One hundred and nineteen patients had 344 surgeries with BVZ therapy before and or after surgery. 11 wound complications (3.20%) of any grade (n=1 CTCAE grade I; n=10 CTCAE grade III) occurred in 11 children (9.24%). Group comparison of BVZ exposure intervals (BVZ ≤28/>28 days and ≤14/>14 days) revealed no statistically significant differences in wound complication rates, with odds ratios of 3.91 (≤28/>28 d; P = .55) and 1.15 (≤14/>14 d; P=1.00) before surgery as well as 1.93 (≤28/>28 d; P = .46) and 3.16 (≤14/>14 d; P = .11) after surgery.

BVZ can be administered within ≤ 28 days before or after surgery when postponing the procedure is not feasible or when immediate (re)initiation of therapy is required, provided that non-absorbable sutures are used, and close wound-monitoring is ensured.