Surgery during regorafenib therapy in children, adolescents, and young adults with bone sarcomas: perioperative management and feasibility
Abstract
BackgroundRegorafenib is an oral multikinase inhibitor with documented activity in relapsed and metastatic bone sarcomas, but data on its perioperative management in children, adolescents, and young adults are scarce. Given its antiangiogenic mechanism and potential impact on wound healing and bleeding risk, defining safe perioperative strategies is essential when surgery is required during ongoing treatment.MethodsThis retrospective analysis of prospectively collected data from the REGBONE clinical trial at the Institute of Mother and Child included children, adolescents, and young adults with relapsed or metastatic osteosarcoma or Ewing sarcoma who received regorafenib and underwent at least one surgical procedure between April 2022 and December 2025. The parent trial enrolled patients aged 9–21 years. Perioperative management involved temporary regorafenib interruption and individualized postoperative resumption guided by predefined wound‐healing criteria. The data cutoff was January 30, 2026.ResultsFourteen patients underwent 18 surgical procedures across 14 regorafenib interruption episodes. The median age at surgery was 16.2 years [IQR 12.8-18.0]; most had osteosarcoma (93%). Thoracic procedures accounted for 67% of surgeries. The median from the last regorafenib dose to the first procedure was 17 days [IQR 11-22]. Regorafenib was resumed after 12 of 14 interruption episodes (86%), with a median of 32 days [IQR 22-48] from the final procedure to resumption. The median total treatment interruption was 67 days [IQR 46-91]. Postoperative complications within 30 days were recorded in two patients (14%; 95% CI 2%-43%), both managed conservatively without surgical reintervention or therapeutic antibiotics; regorafenib was resumed after 70 and 124 days, respectively. No perioperative or 30‐day deaths were recorded among 14 patients, and no 90‐day deaths occurred among 13 evaluable patients. Among 13 patients with planned postoperative chemotherapy, systemic treatment was resumed within 14 days in all cases (median 9 days, IQR 8-10). The median OS from surgery was 29.6 months (95% CI 12.2-not reached), and the 12‐month OS rate was 84.6% (95% CI 51.2%-95.9%).ConclusionsThese findings suggest that surgery during a regorafenib treatment course is feasible in selected children, adolescents, and young adults when treatment interruption is individualized and resumption is guided by clinical wound healing. Early postoperative chemotherapy administration was also feasible in patients for whom it was planned. However, the small cohort and prolonged treatment interruptions limit conclusions regarding safety. Larger multicenter studies are needed to inform perioperative management recommendations.
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BibTeX
@article{zelwianska2026surgery,
title = {{Surgery during regorafenib therapy in children, adolescents, and young adults with bone sarcomas: perioperative management and feasibility}},
author = {A Zelwiańska and K Bilska and T Koziński and T Walenta and I Malesza and A Szymborska and K Bronowicki and B Pachuta and W Jasica and J Antoniuk-Majchrzak and A Raciborska},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1834965},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1834965},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Surgery during regorafenib therapy in children, adolescents, and young adults with bone sarcomas: perioperative management and feasibility
AU - A Zelwiańska
AU - K Bilska
AU - T Koziński
AU - T Walenta
AU - I Malesza
AU - A Szymborska
AU - K Bronowicki
AU - B Pachuta
AU - W Jasica
AU - J Antoniuk-Majchrzak
AU - A Raciborska
PY - 2026
DA - 2026/11/10
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1834965
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1834965
AB - BackgroundRegorafenib is an oral multikinase inhibitor with documented activity in relapsed and metastatic bone sarcomas, but data on its perioperative management in children, adolescents, and young adults are scarce. Given its antiangiogenic mechanism and potential impact on wound healing and bleeding risk, defining safe perioperative strategies is essential when surgery is required during ongoing treatment.MethodsThis retrospective analysis of prospectively collected data from the REGBONE clinical trial at the Institute of Mother and Child included children, adolescents, and young adults with relapsed or metastatic osteosarcoma or Ewing sarcoma who received regorafenib and underwent at least one surgical procedure between April 2022 and December 2025. The parent trial enrolled patients aged 9–21 years. Perioperative management involved temporary regorafenib interruption and individualized postoperative resumption guided by predefined wound‐healing criteria. The data cutoff was January 30, 2026.ResultsFourteen patients underwent 18 surgical procedures across 14 regorafenib interruption episodes. The median age at surgery was 16.2 years [IQR 12.8-18.0]; most had osteosarcoma (93%). Thoracic procedures accounted for 67% of surgeries. The median from the last regorafenib dose to the first procedure was 17 days [IQR 11-22]. Regorafenib was resumed after 12 of 14 interruption episodes (86%), with a median of 32 days [IQR 22-48] from the final procedure to resumption. The median total treatment interruption was 67 days [IQR 46-91]. Postoperative complications within 30 days were recorded in two patients (14%; 95% CI 2%-43%), both managed conservatively without surgical reintervention or therapeutic antibiotics; regorafenib was resumed after 70 and 124 days, respectively. No perioperative or 30‐day deaths were recorded among 14 patients, and no 90‐day deaths occurred among 13 evaluable patients. Among 13 patients with planned postoperative chemotherapy, systemic treatment was resumed within 14 days in all cases (median 9 days, IQR 8-10). The median OS from surgery was 29.6 months (95% CI 12.2-not reached), and the 12‐month OS rate was 84.6% (95% CI 51.2%-95.9%).ConclusionsThese findings suggest that surgery during a regorafenib treatment course is feasible in selected children, adolescents, and young adults when treatment interruption is individualized and resumption is guided by clinical wound healing. Early postoperative chemotherapy administration was also feasible in patients for whom it was planned. However, the small cohort and prolonged treatment interruptions limit conclusions regarding safety. Larger multicenter studies are needed to inform perioperative management recommendations.
SN - 2234-943X
ER -