Balancing benefits and risks: bevacizumab's role in postoperative recovery after spinal oncologic neurosurgery

Spinal oncologic neurosurgery presents considerable therapeutic challenges. Bevacizumab, a monoclonal antibody targeting VEGF, has shown potential to reduce tumor vascularity and postoperative fibrosis. However, its perioperative use raises safety concerns, particularly regarding wound healing.

A systematic search of PubMed, Web of Science, and ClinicalTrials.gov was performed through January 2025. Studies including patients who received Bevacizumab perioperatively for spinal tumors were reviewed. Outcomes included clinical and radiographic response, overall survival, and adverse events. Pooled analyses used random-effects models, and subgroup comparisons were performed. Risk of bias was assessed via the ROBINS-I tool.

Ten studies with 85 patients were included. Clinical improvement occurred in 48% (95% CI: 0.22-0.75), and radiographic improvement in 61% (95% CI: 0.37-0.81). Overall survival across all patients averaged 20.8 months (95% CI: 13.6-31.9). A statistically significant survival benefit was observed in non-glioblastoma (non-GBM) tumors (39.1 months [95% CI: 33.0-46.3]) compared to GBM (16.2 months [95% CI: 9.7-27.0], P=0.0013). Adverse events included fatigue (35%), constipation (31%), hypertension (23%), anemia (22%), and wound infections (22%). No wound dehiscence was reported. Clinical and radiographic responses did not significantly differ between GBM and non-GBM groups, despite histologic differences. Heterogeneity varied across analyses, and risk of bias was generally high due to retrospective designs.

Bevacizumab may offer clinical and radiologic benefit in select spinal tumor patients, particularly in non-GBM histologies, where a significant survival advantage was demonstrated. Though overall response was promising, complication rates, especially fatigue and hypertension, warrant diligence. The absence of reported wound dehiscence is encouraging but must be interpreted in the context of small, heterogeneous cohorts. Further prospective trials are needed to define optimal perioperative use strategies and establish clearer safety margins.