• Deborah T Blumenthal, Andrew A Kanner, Orna Aizenstein, Emanuela Cagnano, Ariel Greenberg, Dov Hershkovitz, Zvi Ram, and Felix Bokstein.
• Neuro-Oncology Service, Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: deborahblumenthal@gmail.com.
• World Neurosurg. 2018 Feb 1; 110: e727-e737.

BackgroundBevacizumab (BVZ) is an antiangiogenic agent approved by the Food and Drug Administration that is used for the treatment of recurrent glioblastoma. Complications related to impaired healing may adversely affect patients resected for recurrent high-grade glioma (HGG) after treatment with BVZ.ObjectiveTo examine the complication rate, outcome, and tumor vasculature in patients resected for recurrent HGG after treatment with BVZ.MethodsData were reviewed retrospectively from patients undergoing surgery for recurrent HGG after treatment with BVZ. Results were compared with a control group of recurrently operated BVZ-naïve HGG. Tumor samples and magnetic resonance imaging scans were analyzed.ResultsFifteen patients underwent HGG resection after progression after BVZ. Forty-four BVZ-naïve patients who underwent surgeries for tumor recurrence were included as controls. Median time from BVZ treatment to surgery was 30 days (2-107). Median overall survival from time of tumor diagnosis was 21.0 months (12-83.0), and median survival from post-BVZ surgery was 5.0 months (2.0-19.0), compared with 8.1 months in BVZ-naïve controls measured from time of their last reoperation. Five of the 15 patients survived 6 or more months after post-BVZ surgery. Nine patients developed postsurgical complications requiring intervention. Complication rates for surgery after BVZ treatment were 66.7% compared with 38.6% in the control group (P = 0.077). We did not see overt changes in histopathology or immunohistochemistry staining; however, tumor vasculature in tumors resected after treatment with BVZ showed a significant decrease in mean vessel density.ConclusionsSurgery for recurrent HGG may be feasible in a select group of patients. Mean tumor vessel density may be decreased after treatment with BVZ.Copyright © 2017 Elsevier Inc. All rights reserved.

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