Impact of bevacizumab chemotherapy on craniotomy wound healing Clinical article
Impact of bevacizumab chemotherapy on craniotomy wound healing Clinical article
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DOI：
10.3171/2010.10.jns101042
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发表时间：
2011-06-01
影响因子：
4.1
通讯作者：
Aghi, Manish K.
中科院分区：
文献类型：
--
作者：
Clark, Aaron J.;Burowski, Nicholas A.;Aghi, Manish K.
目的。 FDA 批准贝伐珠单抗治疗复发性胶质母细胞瘤，导致该患者群体的使用增加。 II 期试验报告称，术后开始使用贝伐单抗会导致 4%-6% 的伤口愈合受损。术前贝伐珠单抗对随后开颅手术愈合的影响尚未得到解决。方法。作者回顾了 2005 年至 2009 年间因复发性胶质母细胞瘤而接受开颅手术的患者病例，评估了贝伐珠单抗治疗/持续时间和愈合并发症（裂开、假性脑膜膨出、脑脊液漏和伤口/骨感染）。 Wilcoxon 秩和检验和 Kruskal-Wallis 检验用于比较组间的连续变量。 Fisher 精确检验用于评估分类变量之间的关联。包括伤口愈合并发症发生率的比较。使用逻辑回归模型来估计伤口愈合并发症的优势比，同时调整基线变量。结果。 209 名患者因复发性胶质母细胞瘤接受了第二次开颅手术（161 名患者）或第三次开颅手术（48 名患者）。二十六人 (12%) 出现伤口愈合并发症。一百六十八名患者未接受贝伐单抗治疗。 23 名患者术前接受贝伐单抗治疗，18 名患者术后接受贝伐单抗治疗。术前接受贝伐单抗治疗的患者出现愈合并发症的比例 (35%) 明显多于未接受贝伐单抗治疗的患者 (10.0%。p = 0.004)。术后贝伐单抗与 6% 的愈合受损相关，与未接受贝伐单抗治疗的对照组没有显着差异 (p = 1.0)。术前贝伐单抗治疗持续时间（周）不影响愈合（OR 0.98。p = 0.55）。在第三次开颅手术前，术前接受贝伐单抗治疗的患者比未接受贝伐单抗治疗的对照患者发生更多的愈合并发症（44% vs 9%。p = 0.03）。结论。尽管受到回顾性研究的局限性，我们证明术前贝伐单抗治疗会导致第二次和第三次开颅手术后的愈合受损，而术后贝伐单抗的效果却很小。对于第三次开颅手术以及贝伐珠单抗和手术之间的延迟时间较短，这种效果更为显着。应该承认这些并发症，因为贝伐单抗使用的增加导致更多接受贝伐单抗治疗后考虑手术治疗复发性胶质母细胞瘤的患者。根据这些结果，作者建议尽可能在最后一次服用贝伐单抗后 28 天以上重复进行开颅手术。 （DOI：10.3171/2010.10.JNS101042）
Object. The FDA approval of bevacizumab for recurrent glioblastoma has resulted in its increased use in this patient population. Phase II trials reported 4%-6% impaired wound healing for bevacizumab initiated postoperatively. The effect of preoperative bevacizumab on subsequent craniotomy healing has not been addressed.Methods. The authors retrospectively reviewed the cases of patients who underwent craniotomy for recurrent glioblastoma between 2005 and 2009. evaluating bevacizumab therapy/duration and healing complications (dehiscence, pseudomeningocele, CSF leak, and wound/bone infection). The Wilcoxon rank-sum test and Kruskal-Wallis test were used to compare continuous variables between groups. The Fisher exact test was used to assess for an association between categorical variables. including the comparison of wound-healing complication rates. Logistic regression models were used to estimate odds ratios of wound-healing complications while adjusting for baseline variables.Results. Two hundred nine patients underwent a second craniotomy (161 patients) or third craniotomy (48 patients) for recurrent glioblastoma. Twenty-six individuals (12%) developed wound-healing complications. One hundred sixty-eight patients received no bevacizumab. 23 received preoperative bevacizumab, and 18 received postoperative bevacizumab. Significantly more patients receiving preoperative bevacizumab developed healing complications (35%) than non bevacizumab-treated patients (10.0%. p = 0.004). Postoperative bevacizumab was associated with 6% impaired healing, not significantly different from non bevacizumab-treated controls (p = 1.0). Preoperative bevacizumab treatment duration (weeks) did not influence healing (OR 0.98. p = 0.55). More healing complications occurred in patients receiving preoperative bevacizumab than in non bevacizumab-treated controls before the third craniotomy (44% vs 9%. p = 0.03).Conclusions. Although subject to the limitations of a retrospective study, we demonstrate that preoperative bevacizumab treatment resulted in impaired healing after a second and third craniotomy, compared with minimal effect of postoperative bevacizumab. This effect is more striking for the third craniotomy and for a shorter delay between bevacizumab and surgery. These complications should be acknowledged as increased bevacizumab use results in more post bevacizumab-treated patients in whom surgery for recurrent glioblastoma is considered. Based on these results, the authors recommend performing repeated craniotomy more than 28 days after last administered dose of bevacizumab whenever possible. (DOI: 10.3171/2010.10.JNS101042)