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Inyección intralesional de bevacizumab para tumores glómicos sintomáticos de la mano: un estudio piloto prospectivo
Shani Svorai Band1, Raphael Israeli1, Gil Gannot1,2
1Orthopaedic Surgery Department, Kaplan Medical Center, 1st Pasternak Road, Rehovot, 7661041, Israel.
Background:
Glomus tumors of the hand are painful vascular neoplasms that are typically treated by surgical excision. However, surgery carries the risk of recurrence, nail deformity, and scarring. Given the highly vascular nature of these tumors, we hypothesized that intralesional inhibition of Vascular Endothelial Growth Factor (VEGF) could reduce tumor vascularity and alleviate pain. This pilot study evaluated the safety, feasibility, and short-term clinical effects of intralesional bevacizumab injections for symptomatic glomus tumors.
Methods:
A prospective, single-center pilot study was conducted on five adult patients with clinically and MRI-confirmed glomus tumors. Under standard digital nerve block and high-frequency ultrasound guidance (18-24 MHz), each patient received a single intralesional injection of bevacizumab (3.75 mg/0.15 mL). The primary outcomes included the Visual Analog Scale (VAS) pain scores at baseline and follow-up. The secondary outcomes included the duration of symptom relief and the histological findings in patients who subsequently underwent surgery. Data were analyzed using descriptive statistical methods.
Results:
The procedure was technically feasible and well tolerated, with no adverse events other than transient, injection-related pressure. The mean VAS pain scores decreased from 7.4 (range, 4-10) at baseline to 2.5 (range, 1-4) at two weeks post-injection. The duration of symptom relief varied from 1 to 12 months. Four patients eventually underwent surgical excision, while one was lost to follow-up after six months. Histopathological analysis of one excised specimen revealed central necrosis, suggesting a potential anti-angiogenic therapeutic effect.
Conclusions:
Intralesional bevacizumab injection is a safe and feasible intervention that provides meaningful but temporary pain relief for glomus tumors of the hand. While surgical excision remains the definitive treatment, this minimally invasive approach may serve as a temporizing measure or a bridge to surgery for patients awaiting surgery or those at high surgical risk.
Level Of Evidence:
IV (prospective pilot study).
