Leijtens Lisa, Piek Jurgen, Verrijssen An-Sofie, Rijkaart Dorien, Wortman Bastiaan, Oele-Egelmeer Ada, Daniëls-Gooszen Alette, Thijs Annemarie, Nijziel Marten, Kolfschoten Sylvie, Bekkers Ruud, Cnossen Jeltsje
Department of Obstetrics and Gynecology Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.
Department of Obstetrics and Gynecology Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.
Gynecol Oncol. 2025 Feb;193:41-48. doi: 10.1016/j.ygyno.2024.12.015. Epub 2025 Jan 7.
To determine the incidence of clinical and subclinical venous thromboembolic events (VTE) in patients with locally advanced cervical cancer (LACC) treated with high-dose thromboprophylaxis during definitive chemoradiation and brachytherapy.
A prospective observational study was undertaken from August 2021 to December 2023 in patients with primary LACC treated with definitive chemoradiation in two Dutch tertiary hospitals. Patients received high-dose thromboprophylaxis during chemoradiation and brachytherapy. In week 4 or 5 of the overall treatment time, plasma D-dimer levels were determined, and all patients underwent venous ultrasound imaging of the legs to screen for deep vein thrombosis (DVT). If indicated, patients received a CT-angiography to screen for pulmonary embolism (PE).
Among 89 included patients, cumulative incidence of clinical and subclinical (V)TE was 7.9 % (n = 7). DVT was found in two patients, PE in three patients, DVT and PE in one patient and one patient had an arterial thromboembolic event (ATE). Of these patients, three (3.4 %) had subclinical VTE, diagnosed during the screening before brachytherapy, and four (4.5 %) had clinical VTE of whom two developed VTE during chemoradiation, one during hospitalization for brachytherapy and one after completing treatment. Of the seven patients with VTE, two (28.6 %) were treated with hyperthermia. Adverse bleeding events after brachytherapy occurred in eight patients.
Routine thromboprophylaxis in patients with LACC leads to a relative low incidence of thromboembolic events during chemoradiation and brachytherapy. Further research should focus on identifying high risk factors leading to targeted screening and prevention of VTE in high risk patients.
确定在局部晚期宫颈癌（LACC）患者接受根治性放化疗和近距离放疗期间采用高剂量血栓预防措施时临床和亚临床静脉血栓栓塞事件（VTE）的发生率。
2021年8月至2023年12月在荷兰两家三级医院对接受根治性放化疗的原发性LACC患者进行了一项前瞻性观察研究。患者在放化疗和近距离放疗期间接受高剂量血栓预防措施。在总治疗时间的第4周或第5周，测定血浆D-二聚体水平，所有患者均接受腿部静脉超声成像以筛查深静脉血栓形成（DVT）。如有必要，患者接受CT血管造影以筛查肺栓塞（PE）。
在纳入的89例患者中，临床和亚临床（V）TE的累积发生率为7.9%（n = 7）。2例患者发现DVT，3例患者发现PE，1例患者同时存在DVT和PE，1例患者发生动脉血栓栓塞事件（ATE）。在这些患者中，3例（3.4%）在近距离放疗前筛查时被诊断为亚临床VTE，4例（4.5%）发生临床VTE，其中2例在放化疗期间发生VTE，1例在近距离放疗住院期间发生VTE，1例在完成治疗后发生VTE。在7例VTE患者中，2例（28.6%）接受了热疗。近距离放疗后有8例患者发生不良出血事件。
LACC患者常规进行血栓预防可使放化疗和近距离放疗期间血栓栓塞事件的发生率相对较低。进一步的研究应集中于识别导致对高危患者进行针对性筛查和预防VTE的高危因素。
