Can emboli form as a result of chemotherapy?

Question

Hi doctor,

The patient has stage 3 rectal cancer. He had brachytherapy radiation last summer. Through surgery, they removed the rectum, surrounding mesorectal fat, and involved lymph nodes. Pathology declared radiation to be a complete response and no cancer was found. FOLFOX chemo has begun 14 months ago for every two weeks to prevent metastatic cancer. The patient also has an aneurysm in his ascending aorta of 2 inches which was initially found on a CT scan due to cancer. The plan is for the repair of the aorta. A chest CT scan with contrast was conducted last week in order to follow the growth of the aneurysm that left the following impression. Multiple bilateral pulmonary emboli involving the left lower lobar pulmonary artery, multiple bilateral segmental and subsegmental pulmonary arteries. The patient has no history of emboli. Multiple scans prior to surgery did not reveal much, so these seem to be the result of either the surgery or the chemotherapy itself, or a combination. The patient has since been put on 1 mL injections of Lovenox, morning and night. He has an infusion of FOLFOX scheduled for this week. This will be round 11 of 12 in total. The patient has two upcoming surgeries planned for this summer. The ileostomy reversal and the repair of his 5.3 cm thoracic ascending aorta. We were hoping to hear the recommendations in regard to proceeding with the infusion as a result of the most recent finding. Will further infusions slow the reabsorption of the emboli and thus delay necessary surgeries? Thank you for your help, expertise, and insight.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

Yes, it appears to be secondary to chemotherapy-induced thrombosis. It is usually secondary to the development of venous thrombi usually in deeper veins of the legs. Prolonged bed rest could be an additional factor along with chemotherapy.
Now that he is on Lovenox (Enoxaparin), the possibility of future thrombus formation is not there. The other thrombus will slowly dissolve and is not dependent on Lovenox therapy or further chemotherapy. Lovenox is given to prevent any future thrombus formation.
As his lung saturation is good and he is physically well, no specific lysis of the thromboemboli is necessary. The only prevention of future thrombus, as is being done through Lovenox should be adequate.
Unless his symptoms worsen physically, he can go for the next cycle. He needs to be on continuous Lovenox therapy until the completion of cycles and until the thrombus gets completely dissolved. Then, after that depending on the risk anticoagulant therapy may be necessary.
For now, if he is physically better with good respiratory function then he can go for the next cycle of chemotherapy.