Increased risk of thromboembolism in esophageal cancer patients treated with neoadjuvant chemoradiotherapy

Dirk J. Bosch, Quirine A. Van Dalfsen, Veronique E. M. Mul, Geke A. P. Hospers, John Th. M. Plukker*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Scopus)


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. (C) 2014 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)215-221
Number of pages7
JournalAmerican Journal of Surgery
Issue number2
Publication statusPublished - Aug-2014


  • Neoadjuvant chemoradiotherapy
  • Esophageal cancer
  • Thromboembolic events

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