Dirk J Bosch1, Quirine A Van Dalfsen1, Véronique E M Mul2, Geke A P Hospers3, John Th M Plukker4. 1. Department of Surgery/Surgical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. 2. Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. 3. Department of Medical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. 4. Department of Surgery/Surgical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. Electronic address: j.t.m.plukker@umcg.nl.
Abstract
BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) patients may increase the formation of thromboembolic events (TEEs). We analyzed the incidence and impact of TEEs in EC patients treated with platinum-based CRT. METHODS: A total of 336 patients with EC underwent an esophagectomy, of which 110 patients received neoadjuvant CRT (41.4 Gy with concurrent Carboplatin/Paclitaxel). Patients were matched based on pre- and perioperative characteristics. RESULTS: Preoperatively, 9 (8.2%) patients with neoadjuvant CRT (P = .004) were diagnosed with TEEs. Despite delay until surgery (P = .021), the postoperative course did not differ. In multivariate analysis, a history of deep vein thrombosis (P = .005) and neoadjuvant CRT (P = .004) were identified as risk factors. Postoperatively, there were no differences in TEEs (P = .560) observed. In multivariate analysis, a history of pulmonary embolism (P = .012) was identified as a risk factor for postoperative TEEs. CONCLUSIONS: Preoperatively, EC patients treated with neoadjuvant CRT have an increased risk to develop a TEE, especially those with a previous history of TEE. After surgery no increased incidence was observed. We recommend secondary prophylaxis during neoadjuvant treatment in this high-risk group.
BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) patients may increase the formation of thromboembolic events (TEEs). We analyzed the incidence and impact of TEEs in EC patients treated with platinum-based CRT. METHODS: A total of 336 patients with EC underwent an esophagectomy, of which 110 patients received neoadjuvant CRT (41.4 Gy with concurrent Carboplatin/Paclitaxel). Patients were matched based on pre- and perioperative characteristics. RESULTS: Preoperatively, 9 (8.2%) patients with neoadjuvant CRT (P = .004) were diagnosed with TEEs. Despite delay until surgery (P = .021), the postoperative course did not differ. In multivariate analysis, a history of deep vein thrombosis (P = .005) and neoadjuvant CRT (P = .004) were identified as risk factors. Postoperatively, there were no differences in TEEs (P = .560) observed. In multivariate analysis, a history of pulmonary embolism (P = .012) was identified as a risk factor for postoperative TEEs. CONCLUSIONS: Preoperatively, EC patients treated with neoadjuvant CRT have an increased risk to develop a TEE, especially those with a previous history of TEE. After surgery no increased incidence was observed. We recommend secondary prophylaxis during neoadjuvant treatment in this high-risk group.
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