Coagulation disorders in patients with locally advanced head and neck cancer – should they really be disregarded?

Abstract

The aim of the study was to analyse coagulation disorders in patients with locally advanced cancer of the head and neck (CHN)and with no other clinical cause for coagulation disorders treated with radiation therapy alone or concurrent chemoradiotherapy. We also assessed the duration of disorders in the course of therapy. The analysed group consisted of 33 patients with locally advanced CHN documented as stage T3 or T4 acc. to the TNM classification. Coagulology tests (activated partial thromboplastic time /APTT/, prothrombin time, fibrinogen concentration, euglobulin lysis time, C - reactive protein and anti-thrombin III concentration, d-dimer level, PAI-1, plasminogen level and plasmin-anti-plasmin assays) were performed before, during and after the completion of treatment. In all cases pre-tratment abnormal fibrinolysis was observed. We observed elevated PAI-1 levels in all blood tests regardless of the treatment stage, while elevated plasminogen concentration and euglobulin lysis time was observed in a majority of tests. Increased PAI-1 level persisted independently of tumor regression during treatment. Half of our patients also presented with a tendency towards shortened APTT. One patient had a significantly higher d-dimer level at the end of the treatment. Decreased APTT was the sole factor influencing overall survial (OS) confirmed in multivariate analysis (Cox's proportinal hazard model). Despite the occurence of abnormal fibrinolysis and decreased APTT, we did not observe an increased risk of coagulation disorders. We conclude that among caogulation tests only a decrease in APTT is, at present, a stasistically confirmed predective factor of shorter OS in CHN patients. Autothrombotic prophylactic treatment may be an effective option in this clinical setting. There is need for further studies on large patient groups.