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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 885-886

Authors' reply to Daddi


Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Submission12-Nov-2020
Date of Decision04-Dec-2020
Date of Acceptance05-Dec-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_352_20

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How to cite this article:
Munot PN, Noronha V, Patil V, Joshi A, Menon N, Prabhash K. Authors' reply to Daddi. Cancer Res Stat Treat 2020;3:885-6

How to cite this URL:
Munot PN, Noronha V, Patil V, Joshi A, Menon N, Prabhash K. Authors' reply to Daddi. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 21];3:885-6. Available from: https://www.crstonline.com/text.asp?2020/3/4/885/305011



We thank Daddi[1] for her valuable comments and suggestions on our article titled, “Cancer thrombosis: Narrative review.”[2]

We agree that tumor thrombus imparts a poor prognosis. Patients who undergo complete resection of the thrombus by surgery have been reported to have a 5-year survival rate of around 50%, whereas those with incomplete thrombus removal have a 5-year survival rate of 10%.[3] Furthermore, positron emission tomography (PET) is valuable for the differentiation of a bland thrombus from a tumor thrombus, as unlike the bland thrombi, the tumor thrombi show fluorodeoxyglucose uptake on PET-computed tomography. “Streak and thread sign” may be seen on angiography with tumor thrombus.[4]

For proximal superficial venous thrombus, the recent National Comprehensive Cancer Network (NCCN) guidelines 2020 suggest the use of anticoagulants at therapeutic doses for a minimum of 6 weeks, followed by reassessment of risk factors and repeat imaging to evaluate the status of the thrombus. If reimaging reveals resolution of the thrombus, anticoagulation can be stopped. If reimaging reveals persistent thrombus, anticoagulation should be continued for an additional 6 weeks. If reimaging reveals increase in the thrombus burden, anticoagulation should be continued for 6 months.[5]

Although there are no specific guidelines for the prophylaxis of venous thromboembolism in patients who are at the end of life, the NCCN recommends that therapeutic anticoagulation should only be administered to patients at the end of life who have symptomatic thrombosis and in whom the anticoagulation leads to symptom relief.[5]

We absolutely agree that in case of venous thrombosis, either de novo or recurrent, in patients with cancer, other causes should always be ruled out, especially in patients with recurrent thrombosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Daddi A. Challenges in Cancer associated thrombosis (CAT). Cancer Res Stat Treat 2020;3:884-5.   Back to cited text no. 1
  [Full text]  
2.
Munot PN, Noronha V, Patil V, Joshi A, Menon N, Prabhash K. Cancer thrombosis: Narrative review. Cancer Res Stat Treat 2020;3:501-16.  Back to cited text no. 2
  [Full text]  
3.
Haddad AQ, Wood CG, Abel EJ, Krabbe LM, Darwish OM, Thompson RH, et al. Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: A contemporary multicenter cohort. J Urol 2014;192:1050-6.  Back to cited text no. 3
    
4.
Raab BW. The thread and streak sign. Radiology 2005;236:284-5.  Back to cited text no. 4
    
5.
Available from: https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf. [Last accessed on 2020 Dec 04].  Back to cited text no. 5
    




 

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