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Please use this identifier to cite or link to this item: http://hdl.handle.net/2262/60884

Title: Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery.
Author: O'DONNELL, JAMES
MAHER, STEPHEN
WHITE, BARRY
PIDGEON, GRAHAM
REYNOLDS, JOHN
Author's Homepage: http://people.tcd.ie/pidgeong
http://people.tcd.ie/jodonne
http://people.tcd.ie/maherst
http://people.tcd.ie/whiteb1
http://people.tcd.ie/reynoljv
Keywords: Oncology
Surgery
oesophageal cancer
Issue Date: 2010
Citation: Byrne M, Reynolds JV, O'Donnell JS, Keogan M, White B, Byrne M, Murphy S, Maher SG, Pidgeon GP, Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery., British Journal of Cancer, 102, 1, 2010, 73-9
Series/Report no.: British Journal of Cancer
102
1
Abstract: Background: The association between cancer, major surgery and venous thromboembolism (VTE) is well established. Multimodal therapy is increasingly being used as standard treatment for localised gastrointestinal cancer. The aim of this study was to examine the markers of pro-coagulation response and VTE risk in an exemplar multimodal model of pre-operative combination chemotherapy and radiation therapy, followed by complex cancer surgery. Methods: Consecutive patients (n=36) with localised oesophageal cancer were studied at baseline after the first and second cycles of chemoradiation, and on post-operative days 1–28, and at 3, 6 and 9 months. Factors regulating the pro- and anti-coagulant response, as well as pro-inflammatory markers including NFκB activation in peripheral blood mononuclear cells, were examined. All patients received enoxaparin 40 mg s.c. postoperatively up to discharge, and underwent pulmonary CT-pulmonary angiography and venography on day 10 postoperatively. Results: Four (11%) non-fatal thromboembolic events were documented, all after hospital discharge. Neoadjuvant therapy before surgery activated factor VIII (FVIII) and pro-inflammatory NFκB, and increased D-dimers, pro-thrombin fragment 1+2 (F1+2) and the thrombin-anti-thrombin complex (TAT). Surgery significantly (P<0.05) increased pro-thrombin time (PT), activated partial thromboplastin time, fibrinogen, D-dimers, TAT, F1+2 and FVIII up to 6 months. Conclusion: These data highlight the linked pro-coagulant and immunoinflammatory pathways in the multimodal management of oesophageal cancer, and suggest that the duration of current standard thromboprophylaxis regimens warrants further study.
Description: PUBLISHED
URI: http://hdl.handle.net/2262/60884
Related links: http://dx.doi.org/10.1038/sj.bjc.6605463
Appears in Collections:Surgery (Scholarly Publications)

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