Thrombosis Risk Associated with Head and Neck Cancer: A Review

Abstract

Venous thromboembolism (VTE) is a common complication for cancer patients. VTE-associated risk varies according to the type of tumor disease. Head and neck cancer is a common cancer worldwide, and most tumors are squamous cell carcinomas due to tobacco and alcohol abuse. The risk of VTE associated with head and neck (H&N) cancer is considered empirically low, but despite the high incidence of H&N cancer, few data are available on this cancer; thus, it is difficult to state the risk of VTE. Our review aims to clarify this situation and tries to assess the real VTE risk associated with H&N cancer. We report that most clinical studies have concluded that there is a very low thrombosis risk associated with H&N cancer. Even with the biases that often exist, this clinical review seems to confirm that the risk of VTE was empirically hypothesized. Furthermore, we highlight that H&N cancer has all the biological features of a cancer associated with a high thrombosis risk, including a strong expression of procoagulant proteins, modified thrombosis/fibrinolysis mechanisms, and secretions of procoagulant microparticles and procoagulant cytokines. Thus, this is a paradoxical situation, and some undiscovered mechanisms that could explain this clinical biological ambivalence might exist.

Analysis of thromboembolic events in head and neck cancer patients who underwent concurrent chemoradiotherapy with cisplatin: A real-world study

“…Incidence of VTE in H&N cancer patients after surgery is generally low (0 ~ 8%), although one study reported higher rate of 26.3% (18,20). While one study reported that H&N cancer is the least common type of cancer diagnosed following VTE, another large study identi ed H&N cancer as the second highest risk for VTE among 18 types of carcinoma (18,19). In a large population-based study, the incidence of TEE in noncancer population was 1.4%, which is similar to the rate of occurrence among H&N cancer patients reported in several studies (18,25).…”

“…Con icting results have been reported regarding the incidence of TEE in H&N cancer patients. According to one meta-analysis, the incidence of VTE in H&N cancer patients was 0.16-3.13% (18). Incidence of VTE in H&N cancer patients after surgery is generally low (0 ~ 8%), although one study reported higher rate of 26.3% (18,20).…”

“…According to one meta-analysis, the incidence of VTE in H&N cancer patients was 0.16-3.13% (18). Incidence of VTE in H&N cancer patients after surgery is generally low (0 ~ 8%), although one study reported higher rate of 26.3% (18,20). While one study reported that H&N cancer is the least common type of cancer diagnosed following VTE, another large study identi ed H&N cancer as the second highest risk for VTE among 18 types of carcinoma (18,19).…”

“…In locally advanced H&N cancer, concurrent chemoradiotherapy (CCRT) with cisplatin is the established standard therapy for de nitive treatment and adjuvant therapy (14)(15)(16)(17). Nonetheless, there are small number of reports regarding the incidence of TEE in H&N cancer with con icting results, without any real-world study which investigated TEE in patients receiving CCRT with cisplatin (18)(19)(20).…”

Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment

“…Kidney, uterus, bladder, lung, colon [35] as well as hematologic malignancies are associated with relatively high risk of thrombosis [37]. Lower risk of thrombotic event is suspected for patients with breast, head and neck or prostate cancer [37,38]. Especially in the treatment of lung, mediastinal, head and neck cancer, the radiation field can involve the PICC and the corresponding venous vessel.…”