title: Use of adjuvant intralesional bevacizumab for aggressive respiratory papillomatosis in children.
abstract: OBJECTIVE
  Juvenile recurrent respiratory papillomatosis (RRP) can be an aggressive disease process necessitating frequent trips to the operating room with multiple anesthetics for tumor debulking and airway preservation. Adjuvant therapy, such as that which is reported in this article, may help reduce the number of operative procedures affected children need each year and therefore may also affect their overall quality of life (QOL).
  
  
  OBJECTIVE
  To describe our experience with intralesional bevacizumab (Avastin) treatment for children with severe RRP by comparing median number of surgical procedures per year, median duration of time between procedures, Derkay staging, and voice QOL before and after bevacizumab treatment.
  
  
  METHODS
  Prospective, consecutive case series.
  
  
  METHODS
  Tertiary care aerodigestive center.
  
  
  METHODS
  Ten children, aged 18 months to 18 years, with severe RRP necessitating more than 4 operative interventions in 1 year whose parents (or legal guardians) consented to intralesional bevacizumab treatment.
  
  
  METHODS
  Intralesional bevacizumab administered at concentration of 2.5 mg/mL for 3 consecutive injections (with 532-nm pulsed KTP [potassium titanyl phosphate] laser when necessary) at intervals of 2 to 3 weeks.
  
  
  METHODS
  Time between surgical procedures, number of procedures per year, Derkay staging, total Pediatric Voice-Related Quality of Life (PVRQOL) score, Emotional PVRQOL score, and Physical PVRQOL score defined by comparing the year leading up to first of 3 bevacizumab injections with the year following the third bevacizumab injection.
  
  
  RESULTS
  The median duration of time between surgical procedures increased by 5.9 weeks after bevacizumab (P = .002). The median number of procedures per year decreased by 4 (P = .002). Derkay staging decreased by 6 (P = .03). The median total PVRQOL score increased by 25.5 (P = .02), the median Emotional PVRQOL score increased by 11.3 (P = .047), and the median Physical PVRQOL score increased by 14.3 (P = .047).
  
  
  CONCLUSIONS
  Intralesional bevacizumab treatment may increase duration of time between surgical procedures and decrease number of procedures per year, while improving voice QOL.
authors.affiliation: Departments of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rogers
authors.forename: Shilpa
authors.initials: S
authors.lastname: Ojha
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000293:Adolescent; D000367:Age Factors; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D001707:Biopsy, Needle; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods; D053685:Laser Therapy / Q000379:methods; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab