TUMOR LYSIS SYNDROME IN SMALL-CELL CARCINOMA AND OTHER SOLID TUMORS

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.