Effect of dalteparin and radiation on survival and thromboembolic events in glioblastoma multiforme: a phase II ECOG trial

Robins, H. Ian; O’Neill, Anne; Gilbert, Mark R.; Olsen, Mark R.; Sapiente, Ronald; Berkey, Brian; Mehta, Minesh P.

doi:10.1007/s00280-007-0596-3

Cited by 55 publications

(35 citation statements)

References 22 publications

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“…However, post-operative low molecular weight heparin is routinely used and has been found to be safe in patients with brain tumors. Low molecular weight heparin has also been shown to reduce the risk of DVT compared to compression stockings after surgical procedures [27][28][29]. In our study, complications of VTE treatment were observed in 16 % (n = 10) of patients.…”

Section: Discussionmentioning

confidence: 76%

Venous thromboembolism (VTE) and glioblastoma

Yust‐Katz

Mandel

et al. 2015

J Neurooncol

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The risk of venous thromboembolism (VTE) is high for patients with brain tumors (11-20 %). Glioblastoma (GBM) patients, in particular, have the highest risk of VTE (24-30 %). The Khorana scale is the most commonly used clinical scale to evaluate the risk of VTE in cancer patients but its efficacy in patients with GBM remains unclear. The aim of this study is to estimate the frequency of VTE in GBM patients and identify potential risk factors for the development of VTE during adjuvant chemotherapy. Furthermore, we intend to examine whether the Khorana scale accurately predicts the risk of VTE in GBM patients. We retrospectively reviewed the medical records of GBM patients treated at MD Anderson during the years 2005-2011. The study cohort included 440 patients of which 64 (14.5 %) developed VTE after the start of adjuvant treatment. The median time to develop VTE was 6.5 months from the start of adjuvant treatment. On multivariate analysis male sex, BMI ≥ 35, KPS ≤ 80, history of VTE and steroid therapy were significantly associated with the development of VTE. The Khorana scale was found to be an invalid VTE predictive model in GBM patients due to poor specificity. Of the 64 patients who developed a VTE, 36 were treated with anticoagulation, 2 with an IVC filter, and 21 with both. Complications (intracranial hemorrhage, bleeding in other organs and thrombocytopenia) secondary to anticoagulation were reported in 16 % (n = 10). VTE is common in patients with GBM. Our results did not validate the Khorana scale in GBM patients. Additional studies identifying which GBM patients are at highest risk for VTE are needed to enable further evaluation of VTE preventive measures in this selected group.

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Section: Discussionmentioning

confidence: 76%

Venous thromboembolism (VTE) and glioblastoma

Yust‐Katz

Mandel

et al. 2015

J Neurooncol

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“…Finally, the high incidence of VTE among glioblastoma patients [33] suggests that anticoagulation prophylaxis may be beneficial. At least three recent prospective trials have investigated the outcomes of high grade glioma patients receiving lowmolecular-weight heparin prophylaxis, yielding modestly positive results with reduction of VTE along with a reasonable safety profile [34][35][36][37]. The use of prophylactic anticoagulation has not yet become common in clinical practice, in part due to ongoing concerns over intracranial hemorrhage [36], especially with the frequent use of bevacizumab for recurrent glioblastoma [38].…”

Section: Discussionmentioning

confidence: 97%

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

et al. 2015

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Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.

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“…In the Eastern Cooperative Oncology Group study, also interrupted prematurely, 45 patients received dalteparin during a median time of 6.3 months, without any occurrence of VTE or ICH [49].…”

Section: Key Pointsmentioning

confidence: 99%