HIGH-RISE OF VASCULAR EVENTS IN PATIENTS WITH UROTHELIAL TRANSITIONAL-CELL CARCINOMA TREATED WITH CISPLATIN-BASED CHEMOTHERAPY

Purpose: We define the incidence of thromboembolic events in patients receiving multiagent chemotherapy for urothelial cancer. Materials and Methods: A retrospective chart review of 271 consecutive patients who received multi-agent cisplatin based chemotherapy for transitional ce ll carcinoma at Princess Margaret Hospital between 1986 and 1996 was p erformed. Indications for chemotherapy included adjuvant treatment fol lowing resection of high risk disease (13%), and primary management of locally advanced and metastatic disease (87%). Results: Vascular even ts occurred in in 35 patients (12.9%) receiving chemotherapy, includin g 18 deep vein thromboses, 9 pulmonary emboli, 7 arterial thromboses, 3 cerebrovascular events, 1 superficial phlebitis and 1 angina pectori s (4 patients had deep vein thrombosis and pulmonary embolus). Three e vents were directly fatal. Overall, 3.6% of chemotherapy cycles were c omplicated by vascular events with 27 events (77%) occurring during th e first 2 cycles. Risk factors for vascular events included a large pe lvic mass and concomitant peripheral vascular or coronary artery disea se. Substantial morbidity was associated with vascular events and medi an hospital stay of 10 days. Conclusions: There is a substantial risk of venous and arterial vascular events in patients receiving cisplatin based chemotherapy for urothelial transitional cell carcinoma. Prophy lactic anticoagulation should be considered in patients with risk fact ors for thromboembolic disease.