The role of bevacizumab as an adjuvant to surgery in recurrent laryngeal papillomatosis: a systematic review of recurrence event outcomes.
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BACKGROUND: Recurrent laryngeal papillomatosis (RPL) is a disease characterized by the formation of papillomas in the larynx, which can compromise the airway, representing a life-threatening risk. Despite surgical management, the disease presents a high recurrence rate, which motivates the search for adjuvant therapies such as Bevacizumab. This study evaluates the effectiveness of Bevacizumab in reducing recurrence rates and prolonging intervals between surgeries. METHODS: A systematic review was performed in PubMed, BVS and Cochrane database, including studies published between 2014 and 2024. Randomized clinical trials and observational studies evaluating Bevacizumab in pediatric and adult patients with PLR were included. The quality of the evidence was assessed with GRADE. Four systematic reviews were included as references for discussion; however, they were excluded because they were not primary studies. RESULTS: Ten studies were included with a total of 173 patients, 69 of whom received Bevacizumab. The age range of treated patients was 0 months to 86 years. Bevacizumab doses ranged from 5-15 mg/kg based on weight, 25mg/ml based on concentration and a single event 400 mg single dose. Before treatment, the recurrence rate ranged from 1-26 surgeries/year and the interval between surgeries ranged from 1 week to 4.34 +- 1.446 months. After treatment, recurrence decreased to 0 to 4 surgeries/year and the intervals extended from 3 months to 14.81 +-12.421 months. The most common side effects, especially with systemic administration, included respiratory complications (glottic stenosis, dysphonia, dyspnea, stridor, aphonia), systemic disturbances (hypertension, mild proteinuria, headache, dysgeusia) and hematological effects (thrombocytopenia). One case of malignant transformation of the lesion was also reported. "follow-up time ranged from 3 months to 5 years. CONCLUSIONS: Bevacizumab is a promising adjuvant therapy for the management of PLR, with significant benefits in reducing recurrence rates and surgical intervals. However, the quality of the available evidence is medium to low, and randomized controlled trials are required to validate its safety and efficacy. Its use should be considered with caution, especially in systemic administration.