Increased risk of thromboembolism in esophageal cancer patients treated with neoadjuvant chemoradiotherapy

Bosch, Dirk; Dalfsen, Quirine A. Van; Mul, Véronique E.; Hospers, Geke A.P.; Plukker, John

doi:10.1016/j.amjsurg.2013.10.031

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…To date scant data have been available describing the risk of TE during nCRT for rectal cancer. Our study represents the largest data set of rectal cancer patients followed for a prolonged period, demonstrating no elevated TE risk, contrary to studies in oesophageal cancer [29] and from the Stockholm rectal cancer trials [24]. Bosch et al [29] reported that 9 of 110 oesophageal .…”

Section: Discussionmentioning

confidence: 56%

“…Our study represents the largest data set of rectal cancer patients followed for a prolonged period, demonstrating no elevated TE risk, contrary to studies in oesophageal cancer [29] and from the Stockholm rectal cancer trials [24]. Bosch et al [29] reported that 9 of 110 oesophageal . In these trials from the 1980s, short-course radiotherapy alone was used with older radiotherapy techniques, and the applicability to current TE risk is uncertain.…”

Section: Discussionmentioning

confidence: 56%

“…Bosch et al . reported that 9 of 110 oesophageal cancer patients developed TE following nCRT and oesophagectomy. Distinct from our cohort, these patients received cisplatin‐based neoadjuvant chemotherapy, a known TE risk factor .…”

Section: Discussionmentioning

confidence: 99%

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Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism

2015

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 56%

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Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism

2015

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“…The top-line findings of the present analysis confirm that GC had the highest risk of VTE when compared with the two other most commonly used chemotherapy regimens for urothelial bladder cancer. Although we recognize that baseline prognostic markers and clinical characteristics could play a role in these outcomes, we found that our outcomes did not The fact that CarboG was associated with a lower VTE risk than GC may be directly related to the use of carboplatin instead of cisplatin in the CarboG regimen; however, carboplatin has been shown to increase VTE risk in some studies [18,19]. For instance, in patients with unresectable or metastatic urothelial carcinoma, Tully et al [19] reported a thromboembolism rate (arterial and venous) of 23.9% in patients treated with CarboG and 14.6% in those treated with GC.…”

Section: Discussionmentioning

confidence: 70%

“…The fact that CarboG was associated with a lower VTE risk than GC may be directly related to the use of carboplatin instead of cisplatin in the CarboG regimen; however, carboplatin has been shown to increase VTE risk in some studies . For instance, in patients with unresectable or metastatic urothelial carcinoma, Tully et al.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer

et al. 2019

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Objective To assess the association of venous thromboembolism (VTE) with different chemotherapy regimens in patients with urothelial tract cancer. Patients and Methods We identified patients aged ≥66 years, diagnosed with urothelial tract cancer in the period 1998 to 2011 in the Surveillance, Epidemiology, and End Results (SEER) Medicare‐linked database. The chemotherapy regimens analysed were gemcitabine/cisplatin (GC), methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), or gemcitabine/carboplatin (CarboG). Propensity scores for treatment regimen based on comorbidities, tumour characteristics, age, and year of diagnosis were calculated. VTE rates within 120 days of chemotherapy initiation were calculated. VTE risk stratified by chemotherapy regimen was modelled using multivariable logistic regression, adjusting for treatment propensity scores and additional demographic characteristics. Overall survival stratified by VTE and chemotherapy regimen was estimated using Kaplan–Meier methods and the log‐rank test. Results Of 5594 identified patients, a VTE occurred in 13.0%. The VTE rates within 120 days of chemotherapy initiation were 15.3% for GC, 8.7% for MVAC, and 12.0% for CarboG. On multivariable analysis, MVAC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39–0.94) and CarboG (OR 0.71, 95% CI: 0.59–0.85) were associated with lower VTE risk compared with GC. VTE was associated with worse overall survival (P < 0.001). Conclusions Compared with GC, MVAC and CarboG were associated with a lower rate of VTE. This finding suggests that gemcitabine may add to the increased thrombosis risk from cisplatin. Additionally, patients with a VTE had worse survival outcomes than those without a VTE. Analysis of the risk of blood clots with different chemotherapy regimens in patients with urothelial tract cancer showed that GC was associated with the highest rate. We also found that blood clots were associated with worse patient outcomes.

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Thromboembolic and bleeding complications in patients with oesophageal cancer

Mulder

Hovenkamp

Laarhoven³

et al. 2020

British Journal of Surgery

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Background In patients who undergo curative treatment for oesophageal cancer, risk estimates of venous thromboembolism (VTE), arterial thromboembolism and bleeding are needed to guide decisions about thromboprophylaxis. Methods This was a single‐centre, retrospective cohort study of patients with stage I–III oesophageal cancer who received neoadjuvant chemoradiation followed by oesophagectomy. The outcomes VTE, arterial thromboembolism, major bleeding, clinically relevant non‐major bleeding and mortality were analysed for four consecutive cancer treatment stages (from diagnosis to neoadjuvant chemoradiotherapy, during neoadjuvant treatment, 30‐day postoperative period, and up to 6 months after postoperative period). Results Some 511 patients were included. The 2‐year survival rate was 67·3 (95 per cent c.i. 63·2 to 71·7) per cent. During the 2‐year follow‐up, 50 patients (9·8 per cent) developed VTE, 20 (3·9 per cent) arterial thromboembolism, 21 (4·1 per cent) major bleeding and 30 (5·9 per cent) clinically relevant non‐major bleeding. The risk of these events was substantial at all treatment stages. Despite 30‐day postoperative thromboprophylaxis, 17 patients (3·3 per cent) developed VTE after surgery. Patients with VTE had worse survival (time‐varying hazard ratio 1·81, 95 per cent c.i. 1·25 to 2·64). Most bleeding events occurred around the time of medical intervention, and approximately one‐half during concomitant use of prophylactic or therapeutic anticoagulation. Conclusion Patients with oesophageal cancer undergoing neoadjuvant chemoradiotherapy and surgery are at substantial risk of thromboembolic and bleeding events throughout all stages of treatment. Survival is worse in patients with thromboembolic events during follow‐up.

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Increased risk of thromboembolism in esophageal cancer patients treated with neoadjuvant chemoradiotherapy

Cited by 25 publications

References 17 publications

Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism

Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism

Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer

Thromboembolic and bleeding complications in patients with oesophageal cancer

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