scholarly journals The increased risk for thromboembolism pre-cystectomy in patients undergoing neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer is mainly due to central venous access: a multicenter evaluation

2019 ◽  
Vol 52 (4) ◽  
pp. 661-669 ◽  
Author(s):  
Kristoffer Ottosson ◽  
Sofia Pelander ◽  
Markus Johansson ◽  
Ylva Huge ◽  
Firas Aljabery ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Central Venous Access ◽  
Urinary Bladder Cancer ◽  
Venous Access ◽  
Central Venous ◽  
Chemotherapy Administration ◽  
Increased Risk ◽  
Chi Squared ◽  
Muscle Invasive

Abstract Purpose To investigate if patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) had an increased risk of thromboembolic events (TEE) and to evaluate when these events occur on a timeline starting from 6 months pre-cystectomy, during NAC-administration and 60 months post-cystectomy. Methods Two hundred and fifty five patients undergoing radical cystectomy during 2009–2014 at three Swedish cystectomy centers (Umeå, Linköping and Sundsvall) were in-detail reviewed retrospectively, using individual medical records. One hundred and twenty nine patients were ineligible for analysis. NAC patients (n = 67) were compared to NAC-naïve NAC-eligible patients (n = 59). The occurrence of TEE was divided into different periods pre-cystectomy and post-cystectomy. Statistical analyses included Chi-squared and logistical regression tests. Results Significant associations were found between receiving NAC and acquiring a TEE during NAC therapy pre-cystectomy. All but one pre-cystectomy event was venous and all but one of the patients received NAC. 31% (14/45) of TEEs occurred pre-cystectomy. The incidence of TEEs pre-cystectomy in NAC-naive NAC-eligible patients was only 10% (2/20), whereas the incidence of TEEs in NAC patients occurred pre-cystectomy in 48% (12/25) and 11/12 incidents were detected during NAC therapy—this including 7/11 (64%) incidents affecting veins in anatomical conjunction with the placement of central venous access for chemotherapy administration. Conclusions There is a significantly increased risk for TEE pre-cystectomy during chemotherapy administration in MIBC patients receiving NAC, compared to the risk in NAC-naïve NAC-eligible MIBC patients. In 64% of the pre-RC TEEs in NAC patients, there was a clinical connection to placement of central venous access.

scholarly journals Thromboembolic events during neoadjuvant chemotherapy in muscle invasive bladder cancer – any correlation to the central venous access? A clinical practice article

F1000Research ◽  
2022 ◽  
Vol 11 ◽  
pp. 40
Author(s):  
Victoria Eriksson ◽  
Elisabeth Eriksson ◽  
Amir Sherif
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Central Venous Access ◽  
Venous Access ◽  
Invasive Bladder Cancer ◽  
Thromboembolic Events ◽  
Central Venous ◽  
Muscle Invasive Bladder Cancer ◽  
Risk Increase ◽  
Muscle Invasive

Patients with muscle invasive bladder cancer have a generally known 5-year overall survival of approximately 58% with neoadjuvant chemotherapy (NAC). During the last decades, addition of Cisplatinum-based NAC in fit patients prior to radical cystectomy (RC), has significantly improved OS, compared to RC only. However, some published studies following NAC addition, describe an intermediate risk increase of thromboembolic events (TEEs). Placement of central venous access (CVA) before NAC has also been suggested as being a potential risk factor for thrombosis. We present a combination of images and cases from the Northern Swedish health region where three patients developed venous TEE after CVA placement for NAC-administration and found that the time until curable RC was prolonged circa one month each, with an addition of one RC cancelled. These are serious events and to our knowledge, there are no current guidelines on prevention of TEE before RC. The aim with this report was to provide examples of these events and conclude that further prospective trials are warranted on prevention and future guidelines regarding venous anticoagulant treatment for TEE that occur pre-RC in NAC-patients.

Multidisciplinary management and use of neoadjuvant cisplatin combination chemotherapy in patients with muscle-invasive urothelial bladder cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15012-e15012
Author(s):  
Jean H. Hoffman-Censits ◽  
Jianqing Lin ◽  
Costas D. Lallas ◽  
Timothy Norman Showalter ◽  
Robert Benjamin Den ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Center ◽  
Chemotherapy Administration ◽  
Medical Oncologists ◽  
Urothelial Bladder ◽  
Historic Data ◽  
Muscle Invasive ◽  
Evidence Based Guidelines ◽  
Lost To Follow Up

e15012 Background: Although randomized data support neoadjuvant cisplatin-based chemotherapy prior to cystectomy for muscle invasive bladder cancer (MIBC), a recent retrospective study of 14 academic centers demonstrated only 12% of patients eligible for cystectomy received neoadjuvant chemotherapy. We reviewed utilization of neoadjuvant chemotherapy in a cohort of patients with MIBC seen at the Genitourinary Multidisciplinary Cancer Clinic (GUMDCC) of the Kimmel Cancer Center at Thomas Jefferson University (TJU). Methods: With IRB approval, records were reviewed for patients seen in the GUMDCC by urologists, radiation and medical oncologists with MIBC expertise from August 2009 to August 2011. Results: Of the201 patients with bladder or urothelial carcinoma, 46 (23%) with T2-T4 MIBC were identified and evaluated for neoadjuvant chemotherapy prior to radical cystectomy. 14 of 46 (30%) had renal, cardiac or other comorbidities rendering them unfit for cisplatin or cystectomy, and 2 were never referred to medical oncology. Of the 30 patients eligible for cisplatin and cystectomy, 2 were treated at outside institutions, 4 were recommended for treatment but were lost to follow up, and 4 who had refused neoadjuvant chemotherapy had adverse pathology at cystectomy and received adjuvant chemotherapy. Twenty eligible patients (66%) initiated neoadjuvant chemotherapy at TJU, 8 of those (40%) on clinical trial. 100% of patients treated with neoadjuvant chemotherapy at TJU received cisplatin based regimens, and 17 of 20 patients received at least 3 cycles. Chemotherapy was initiated in an average of 29.8 days of multidisciplinary evaluation. Conclusions: Multidisciplinary evaluation and management of patients with MIBC leads to improved compliance with evidence based guidelines and higher rates of cisplatin based neoadjuvant chemotherapy administration compared with historic data.

Clinical and pathological outcomes for patients with T1HG bladder cancer managed with upfront cystectomy with or without neoadjuvant chemotherapy and the impact of the MDACC high-risk features.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 366-366
Author(s):  
Michael J. Metcalfe ◽  
James Edward Ferguson ◽  
Roger Li ◽  
Lianchun Xiao ◽  
Colin P.N. Dinney ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Neoadjuvant Chemotherapy ◽  
Systemic Disease ◽  
Survival Outcomes ◽  
Increased Risk ◽  
Node Positive Disease ◽  
Variant Histology ◽  
Muscle Invasive ◽  
The Impact

366 Background: In muscle invasive bladder cancer there is an increased risk for systemic disease identified for patients with certain high risk features (HRF): pre-operative hydronephrosis (POH), lymphovascular invasion (LVI), abnormal exam under anesthesia (AbnEUA), and the presence of variant histology (VH). We sought to identify the effect of these high risk features in the T1HG population. Methods: With IRB approval, a single center retrospective review was performed on all patients at MDACC from 1995-2013 who underwent radical cystectomy (RC) for T1HG urothelial cancer. Patients were stratified according to the presence or absence of HRF defined by the presence of LVI, POH, VH, AbnEUA, prostatic ductal involvement (PDI), and the delivery of neoadjuvant chemotherapy (NAC). Primary outcome included pathologic T (pT) upstage and presence of lymph node positive disease (LN+) at time of RC, as well as survival outcomes. Results: 372 T1HG patients underwent RC, of these 196 (53%) have HRF including: VH (n=98, 25%), LVI (n=44, 12%), PDI (n=31, 8%), POH (n=38, 10%) and/or AbnEUA (n=34, 9%). pT upstage occurred in 43/176 (24.4%) of patients without HRF, in 45/151 (30%) of patients with 1 HRF, and in 38% (17/45) of patients with > 2 HRF (p=0.088). LN+ occurred in 18/176 (10.2%) of patients without HRF, 7.8% (15/151) of patients with 1 HRF and in 17.8% (8/45) of patients with > 2 HRF (p=0.0403). Presence of HRF were not significant for a decreased OS (p=0.076), DSS (0.425), and RFS (p=0.103). No patients without HRF got NAC, and 41/196 (21%) of patients with HRF received NAC. There was no effect of NAC on pT upstage (OR 1.184, 95% CI 0.355-3.954, p=0.7834) or rate of LN+ disease (OR 1.758, 95% CI 0.669-5.606, p=0.2525) on multivariate analysis. There was no effect of NAC on OS (p=0.122), DSS (0.437), or RFS (0.7483). Conclusions: Presence of certain high risk features in the T1HG setting does have increased risk of pT upstage and LN+ disease in patients treated with cystectomy. However, there is no effect seen on survival outcomes. Use of NAC did not significantly alter outcome in our cohort and should be reserved for the muscle invasive setting.

scholarly journals Systematic Review and Meta-Analysis of Cisplatin Based Neoadjuvant Chemotherapy in Muscle Invasive Bladder Cancer

2021 ◽  
pp. 1-13
Author(s):  
Raed Benkhadra ◽  
Tarek Nayfeh ◽  
Sai Krishna Patibandla ◽  
Chelsea Peterson ◽  
Larry Prokop ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Meta Analysis ◽  
Nausea And Vomiting ◽  
Phase Iii ◽  
Invasive Bladder Cancer ◽  
Efficacy And Safety ◽  
Muscle Invasive Bladder Cancer ◽  
Increased Risk ◽  
Muscle Invasive

BACKGROUND: Cisplatin-based neoadjuvant chemotherapy is the standard of care for muscle invasive bladder cancer (MIBC). OBJECTIVE: To compare the efficacy and safety of the two most commonly used cisplatin-based regimens; gemcitabine, and cisplatin (GC) vs. accelerated (dose-dense: dd) or conventional methotrexate, vinblastine, adriamycin, and cisplatin (MVAC). METHODS: We searched MEDLINE, Embase, Scopus and other sources. Outcomes of interest included overall survival, downstaging to pT≤1, pathologic complete response (pCR), recurrence, and toxicity. Meta-analysis was conducted using the random-effects model. RESULTS: We identified 24 studies. Efficacy outcomes were comparable between MVAC and GC for MIBC. dd-MVAC was associated with favorable efficacy compared to GC in terms of downstaging (OR 1.45; 95%CI 1.15–1.82) and all-cause mortality at longest follow-up (OR 0.63; 95%CI 0.44–0.81). However, GC was associated with a better safety profile in terms of febrile neutropenia (OR 0.32; 95%CI 0.13–0.80), anemia (OR 0.32; 95%CI 0.18–0.54), nausea and vomiting (OR 0.27; 95%CI 0.12–0.65) compared to dd-MVAC. Compared to MVAC, patients receiving GC had an increased risk of developing grade 3–4 thrombocytopenia (OR 4.70; 95%CI 1.59–13.89) and a lower risk of nausea and vomiting (OR 0.05; 95%CI 0.01–0.31). Certainty in the estimates was very low for most outcomes. CONCLUSIONS: Efficacy and safety outcomes were comparable between MVAC and GC for MIBC. Including non-peer-reviewed studies showed higher efficacy with dd-MVAC. A phase III randomized trial comparing the two regimens is needed to guide clinical practice.

Incidence of venous thromboembolism in patients with hematologic malignancies related to upper extremity peripherally inserted central venous catheters.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6586-6586
Author(s):  
Thomas A. Giever ◽  
Emily L. Richter ◽  
Kristine M. Broge ◽  
Patrick C. Foy ◽  
Linda S. Blust ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Plasma Cell ◽  
Central Venous Access ◽  
Hematologic Malignancies ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Lymphoproliferative Disorders ◽  
Central Venous ◽  
Increased Risk ◽  
Plasma Cell Dyscrasias

6586 Background: Central venous catheters (CVCs) are an integral part of management in patients with hematological malignancies (HMs). CVCs are not without risk however, including DVT which adds significant morbidity. Peripherally inserted central venous catheters (PICCs) via the brachiocephalic veins were the most common CVCs utilized at the Medical College of Wisconsin for patients with HMs. Recent evidence has indicated an increased risk of DVT in patients with PICCs. Methods: We retrospectively reviewed patients admitted to our institution from 2009-2011 with a HM and a CVC placed based upon CPT codes. A chart review was performed and those with a radiologic-confirmed DVT were identified. Results: From 2009-2011, 487 patients with HMs had 1091 CVCs placed. Diagnoses included lymphoproliferative disorders (35.8%), acute leukemia excluding APL (23.8%), APL (1.6%), plasma cell dyscrasias (34.6%), MDS (1.7%), CML (1.6%), and other diagnoses (0.7%). Of the CVCs placed 51% were in patients undergoing stem cell transplantation (HCT) and 49% were placed in non-HCT patients. A total of 91 DVTs were documented and confirmed. DVTs occurred in 85 of 728 PICCs (11.7%), 3 of 104 implanted ports (2.9%), 3 of 249 tunneled CVCs (1.2%), and 0 of 10 other CVCs. DVT rates were similar between HCT (47 of 556, 8.4%) and non-HCT (44 of 535, 8.2%) patients. The highest number of DVTs were associated with plasma cell dyscrasias (29 of 378, 7.7%) followed by lymphoproliferative disorders (28 of 391, 7.2%), acute leukemia (26 of 260, 10%), APL (3 of 18, 16.6%), MDS (3 of 19, 15.8%), and CML (2 of 17, 11.7%). Two DVTs occurred in the setting of warfarin therapy, 5 while on prophylactic and 9 while on therapeutic LMWH. The mean duration from line placement to DVT was 21 days (range 1-169). Using standard chi-squared evaluation, PICC lines were significantly more likely to be associated with DVTs than tunneled or implanted CVCs (p<0.0001). Conclusions: Brachiocephalic PICC-lines are associated with a high incidence of DVT in patients with HMs compared to other CVCs. We have currently changed our practice to utilizing a tunneled internal jugular PICCs for central venous access.

scholarly journals Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242727
Author(s):  
Amine Souadka ◽  
Hajar Essangri ◽  
Imad Boualaoui ◽  
Abdelilah Ghannam ◽  
Amine Benkabbou ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Intraoperative Complications ◽  
Central Venous Access ◽  
Venous Access ◽  
Demographic Characteristics ◽  
Success Rates ◽  
Central Venous ◽  
Chemotherapy Administration ◽  
Significant Difference ◽  
Ultrasonographic Guidance

Introduction The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). Material and methods This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. Results Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. Conclusion In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.

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