title: Increased risk of thromboembolism in esophageal cancer patients treated with neoadjuvant chemoradiotherapy.
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.
authors.affiliation: Department of Surgery/Surgical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Bosch
authors.affiliation: Department of Surgery/Surgical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Quirine A
authors.initials: QA
authors.lastname: Van Dalfsen
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Véronique E M
authors.initials: VE
authors.lastname: Mul
authors.affiliation: Department of Medical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Geke A P
authors.initials: GA
authors.lastname: Hospers
authors.affiliation: 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.
authors.forename: John Th M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D016629:Esophagectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel
keywords: Esophageal cancer; Neoadjuvant chemoradiotherapy; Thromboembolic events