Venous thromboembolism in radiation therapy cancer patients: Findings from the RIETE registry

Guy, J.-B.; Bertoletti, Laurent; Magné, Nicolas; Rancoule, C.; Mahé, Isabelle; Font, Carme; Sanz, O.; Martín‐Antorán, J.M.; Pace, F.; Vela, J.; Monreal, Manuel

doi:10.1016/j.critrevonc.2017.03.006

Cited by 51 publications

(44 citation statements)

References 36 publications

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“…Older patients with lung cancer are susceptible to multiple risk factors for PE, including (1) patient-related factors such as advanced age, immobilization, hyperglycemia, hyperlipidemia, and smoking 18 ; (2) malignant cell-related factors 19 , including the production of procoagulant, fibrinolytic, and proaggregating conditions; release of proinflammatory and proangiogenic cytokines; and interaction with vascular and blood cells; (3) treatment-related factors such as radiotherapy 20 , chemotherapy 21 , surgery 22 , and central venous catheterization 23 ; and (4) complications 24 such as infection, heart failure, renal disease, and pulmonary disease. Therefore, to the risk of PE should be considered in older patients with a malignancy.…”

Section: Discussionmentioning

confidence: 99%

Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis

Liu

Wang

Yuan

et al. 2020

Sci Rep

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older patients, especially those with malignancy, may have an increased risk of pulmonary embolism (pe). However, few studies have evaluated the clinical characteristics and prognosis of older patients. We evaluated the clinical characteristics, prognosis, and risk factors in older patients with lung cancer complicated with pe. this was a single-center, prospective cohort study. older patients (≥65 years) with lung cancer admitted in Beijing Hospital from January 2006 to December 2016 were enrolled. The patients were divided into two groups according to the presence of pe using propensity score matching (PSM). After PSM, one hundred and six patients (53 per group) with an average age of (77.3 ± 10.9) years were enrolled. Adenocarcinoma was the most common histology in patients with PE (52.8%, n = 28), and most lung cancer patients were in stages III and IV (59.4%, n = 63). Patients with PE were stratified to low risk (52.8%, n = 28), intermediate-low risk (24.5%, n = 13), intermediate-high risk (15.1%, n = 8), high-risk (7.5%, n = 4) subgroups. Most PE patients presented with dyspnea (75.5%), and the majority of patients (86.8%, n = 46) developed PE within 3 months after the diagnosis of cancer. The median follow-up time was 23.7 months (12.0-62.0 months), and 7 patients (6.6%) were lost to follow-up. During the follow-up period, 92 patients (86.8%) died, including 8 cases (8.7%) of PE-related death, 73 (79.3%) of tumor death, and 11 (11.9%) of unknown cause. There were significant differences in all-cause mortality (94.3% vs. 83.0%) and PE-related mortality (15.1% vs. 0) between the PE and control groups, but the rate of tumor-related mortality (75.5% vs. 66.0%) was comparable between the groups. Among the 92 patients who died, the mortality rates at 3, 6, 12, and > 12 months after tumor diagnosis were 33.0% (33/106), 57.5% (61/106), 78.3% (83/106), and 89.6% (95/106), respectively. Kaplan-Meier survival analysis showed that the median overall survival time was significantly different between the PE and the control groups (4.3 vs. 9.2 months, P = 0.0015). Multivariate stepwise logistic regression analysis showed that age ≥ 77 years (OR = 2.58, 95%CI: 1.66-4.01), clinical stage III-IV (OR = 2.21, 95%CI: 1.03-4.74), adenocarcinoma (OR = 3.24, 95%CI: 1.75-6.00), high D-dimer (≥600 mg/L) (OR = 2.73, 95%CI: 1.25-5.96), and low partial pressure of oxygen (PaO 2 ; <75 mmHg) (OR = 2.85, 95%CI: 1.74-4.67) were independent risk factors for PE in older patients with lung cancer. Older patients with lung cancer and PE often have poor prognosis. Advanced age, clinical stage III-IV, adenocarcinoma, high D-dimer level, and low PaO 2 are independent risk factors for pe.With age, older individuals are at high risk of thromboembolic events. Cancer is an established cause of venous thrombosis 1 ; once a thrombus forms, venous thromboembolism (VTE) and even pulmonary embolism (PE) can result, leading to serious adverse events such as heart failure, respiratory failure, and sudden death. The prevalence of malignancy in patients with...

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Section: Discussionmentioning

confidence: 99%

Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis

Liu

Wang

Yuan

et al. 2020

Sci Rep

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“…A relação causal entre a radioterapia e o aumento de mortes por TEP não é bem entendida. O TEP é uma causa conhecida de mortalidade em pacientes com câncer em geral, sendo sua incidência quatro a seis vezes maior nesses pacientes do que na população em geral 32 . Além do aumento de risco de trombose pelo próprio câncer, a terapia oncológica aumenta ainda mais o risco de TEP.…”

Section: Mortalidade Cardiovascular Ligada Ao Sobretratamento Com Radunclassified

“…Além do aumento de risco de trombose pelo próprio câncer, a terapia oncológica aumenta ainda mais o risco de TEP. Isso está bem estabelecido para cirurgia, quimioterapia e hormonioterapia, sendo ainda pouco conhecido no caso da radioterapia 32 . Um metanálise de ensaios clínicos de radioterapia adjuvante para câncer de mama mostrou aumento de mortalidade por TEP nessas pacientes (RR de 1,94) 33 .…”

Section: Mortalidade Cardiovascular Ligada Ao Sobretratamento Com Radunclassified

“…Um metanálise de ensaios clínicos de radioterapia adjuvante para câncer de mama mostrou aumento de mortalidade por TEP nessas pacientes (RR de 1,94) 33 . O possível mecanismo fisiopatológico seria destruição celular e promoção de processos inflamatórios pró-trombóticos pela radiação ionizante 32 .…”

Section: Mortalidade Cardiovascular Ligada Ao Sobretratamento Com Radunclassified

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Mortalidade Cardiovascular Associada ao Rastreamento Mamográfico

Migowski

Nadanovsky

Vianna

2019

Rev. Brasileira.De.Cancerologia

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Introdução: Os danos cardiovasculares do rastreamento mamográfico não têm sido objeto de estudo ou preocupações, inclusive na área de cardio-oncologia. O resultado é uma importante lacuna na literatura a despeito de evidências da grande magnitude do sobrediagnóstico e do sobretratamento no rastreamento e sua ligação com aumento da mortalidade cardiovascular. Objetivo: Apresentar e discutir as principais evidências a respeito das causas de aumento de mortalidade cardiovascular associadas ao rastreamento. Método: Foram realizadas buscas sistemáticas na literatura, por meio de quatro estratégias de busca em duas bases de dados (MEDLINE e LILACS), para identificar as causas de aumento de mortalidade cardiovascular potencialmente associadas ao sobrediagnóstico e ao sobretratamento. Para cada uma das estratégias de busca, os resultados tiveram seu nível de evidência atribuídos de acordo com a classificação do Oxford Centre for Evidence-Based Medicine. Resultados: Dois grandes grupos de causas de aumento da mortalidade cardiovascular foram identificados: o primeiro ligado diretamente ao diagnóstico de câncer de mama; e o segundo ao tratamento do câncer de mama, incluindo cirurgia e radioterapia adjuvante. O aumento de mortalidade cardiovascular incluiu diversos subgrupos de causas, tais como infarto agudo do miocárdio, tromboembolismo pulmonar, insuficiência cardíaca, arritmias, doença orovalvar e acidente vascular encefálico. Conclusão: Existem evidências consistentes sobre mortalidade cardiovascular associada ao diagnóstico e ao tratamento do câncer de mama em situações clinicamente compatíveis com o rastreamento. É provável também que essa seja uma das causas mais importantes da mortalidade relacionada ao rastreamento, em especial aquelas associadas ao sobretratamento com radioterapia adjuvante.

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“…They usually resolve 6-8 weeks after the treatment and they disappear up to 3 months in most cases (12). Oropharyngeal and laryngeal cancer patients treated with RT were found to be at higher risk of developing venous thromboembolism (VTE) compared to their radiation-spared counterparts (13,14). The prevalence of VTE among HNC patients undergoing surgery is 1.4-5.8%, and can be as high as 13% when asymptomatic VTE cases are included (15).…”

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confidence: 99%

Endothelial Microparticles and Blood Coagulation Activation in Head and Neck Cancer Patients Undergoing Radiotherapy or Radiochemotherapy

Sierko

Sobierska

Zabrocka

et al. 2019

In Vivo

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Background/Aim: Endothelial microparticles (EMP) are small vesicles which are released from the endothelium and contribute to blood coagulation activation in various clinical settings. The aim of this study was to examine whether EMP influence blood coagulation activation in cancer patients during radiotherapy/ radiochemotherapy (RT/RCT). Materials and Methods: Sixteen head and neck cancer (HNC) patients undergoing RT/RCT and 10 controls were examined. EMP and thrombin-antithrombin complex (TAT) were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA), respectively. Tissue factor-positive EMP (TF + EMP) were defined as CD31 + /CD142 + /CD42b -. Results: TF + EMP were significantly elevated in HNC patients before RT/RCT (T 0 ) (1299±1154/μl), one day after RT/RCT (T 1d ) (1257±603/μl) and 3 months after RT/RCT (T 3m ) (1289±372/μl) compared to controls (688±647/μl). TF + EMP levels at T 0 /T 1d and T 0 , as well as at T 1d and T 3m were not significantly different. TAT levels at T 0 and T 1d did not differ significantly but at T 3m were significantly lower compared to T 0 and T 1d . TF + EMP and TAT concentrations were not significantly correlated at T 0 (r=0. 058; p=0.828), T 1d (r=0.373, p=0.154) and T 3m (r=-0.302, p=0.204).

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Venous thromboembolism in radiation therapy cancer patients: Findings from the RIETE registry

Cited by 51 publications

References 36 publications

Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis

Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis

Mortalidade Cardiovascular Associada ao Rastreamento Mamográfico

Endothelial Microparticles and Blood Coagulation Activation in Head and Neck Cancer Patients Undergoing Radiotherapy or Radiochemotherapy

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