title: High-dose sublesional bevacizumab (avastin) for pediatric recurrent respiratory papillomatosis.
abstract: OBJECTIVE
  We review and report the use of high-dose bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP) in pediatric patients.
  
  
  METHODS
  We included all patients with pediatric-onset RRP who underwent bevacizumab (25 mg/mL) injections by a single practitioner. A series of 5 consecutive subepithelial injections were administered at 4- to 6-week intervals with concomitant 532 nm KTP laser ablation. The lesions were staged according to the Derkay staging system. The outcomes included pretreatment and posttreatment Derkay scores, the time interval between procedures, and voice outcomes. The demographic data extracted included sex, age at diagnosis, and current age.
  
  
  RESULTS
  Nine patients were included in this study, with 1 patient lost to follow-up; their median age was 8 years (range, 3 to 21 years). The mean bevacizumab dose was 14.25 mg (range, 5 to 45 mg). There was a median Derkay score of 11.5 (range, 4 to 23) at the time of diagnosis and a median 58% improvement following therapy. All patients demonstrated an increased time interval between injections, for a median improvement of 2.05× (range, 1.6× to 3.25×).
  
  
  CONCLUSIONS
  Evidence exists in support of vascular endothelial growth factor as an important factor in the development of RRP. Although some variability in response is demonstrated by this study, high-dose bevacizumab appears to yield promising results for pediatric patients with RRP.
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Boston, Cincinnati, Ohio, USA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Sidell
authors.forename: Michel
authors.initials: M
authors.lastname: Nassar
authors.forename: Robin T
authors.initials: RT
authors.lastname: Cotton
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zeitels
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Alarcon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: bevacizumab; papilloma; pediatrics; recurrent respiratory papillomatosis