Gp. Kalemkerian et al., TUMOR LYSIS SYNDROME IN SMALL-CELL CARCINOMA AND OTHER SOLID TUMORS, The American journal of medicine, 103(5), 1997, pp. 363-367
OBJECTIVE: TO review the risk factors and clinical findings associated
with tumor lysis syndrome (TLS) in patients with small cell carcinoma
s and other solid tumors. METHODS: Reports of TLS in the English-langu
age literature were identified by searching MEDLINE and the bibliograp
hies of relevant case reports, journal articles, and book chapters. Al
l reports identified through these searches, including abstracts from
national meetings, were reviewed and included in this analysis. Data r
egarding clinical and biochemical parameters relevant to the occurrenc
e of TLS were extracted from each report. RESULTS: Of the 25 reported
solid tumor patients who developed TLS, 7 had small cell carcinoma, 5
breast cancer, and 4 neuroblastoma. TLS was associated with a variety
of treatment regimens, including chemotherapy, immunotherapy, hormonal
therapy, radiation therapy, and surgery. Common risk factors for TLS
in this population included pretreatment renal insufficiency, elevated
serum lactate dehydrogenase (LDH), and hyperuricemia. Among the typic
al biochemical findings of TLS, acute renal insufficiency and hyperuri
cemia were identified in nearly all patients and hyperkalemia, hyperph
osphatemia, hypocalcemia, and increased serum LDH were reported in ove
r 75% of patients. In addition, seven patients, including the current
case, presented with profound metabolic acidosis. Nine of 25 patients
died during the acute episode of TLS. CONCLUSIONS: Although TLS occurs
infrequently in patients with solid tumors, the risk factors and bioc
hemical abnormalities associated with this potentially fatal complicat
ion of therapy must be recognized to allow for adequate monitoring and
early initiation of appropriate therapeutic measures. (C) 1997 by Exc
erpta Medica, Inc.