title: Cisplatin chemotherapy (without erythropoietin) and risk of life-threatening thromboembolic events in carcinoma of the uterine cervix: the tip of the iceberg? A review of the literature.
abstract: BACKGROUND
  The risk of severe cardiovascular toxicity, specifically thromboembolic events (TE), in patients with cervical cancer receiving concurrent irradiation and cisplatin chemotherapy is reported to be less than 1% in several large prospective trials. However, the anecdotal risk appears to be far higher.
  
  
  CONCLUSIONS
  A review of several prospective trials demonstrates no treatment related grade 4 cardiovascular toxicities and only two grade 5 toxicities in 1424 (0.1%) collective patients. A recent publication and our own unpublished experience finds 6 of 128 (4.7%) patients developed grade 4 to 5 cardiovascular (thrombosis/embolism) toxicity. The difference in incidence of severe or life threatening cardiovascular toxicity of 0.1 versus 4.7% is highly statistically significant (p < 0.00001.)
  
  
  CONCLUSIONS
  This dramatic difference in incidence of cardiovascular toxicity raises the possibility that cardiovascular toxicities were inadequately reported on the listed prospective trials. For those patients enrolled in prospective trials, we suggest that thromboses should be diligently documented and reported. Only after the true incidence of thromboses is established can we implement appropriate levels of early screening and intervention that may prevent life threatening complications.
authors.affiliation: Radiation Oncology Associates, Albuquerque NM 87109, USA. andersj11@hotmail.com
authors.forename: Jon C
authors.initials: JC
authors.lastname: Anders
authors.forename: Perry W
authors.initials: PW
authors.lastname: Grigsby
authors.forename: Anurag K
authors.initials: AK
authors.lastname: Singh
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004921:Erythropoietin / Q000378:metabolism / Q000494:pharmacology*; D005260:Female; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D012107:Research Design; D012189:Retrospective Studies; D013923:Thromboembolism / Q000139:chemically induced* / Q000401:mortality* / Q000517:prevention & control; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000532:radiotherapy
chemical_list: D000970:Antineoplastic Agents; D004921:Erythropoietin; D002945:Cisplatin