Title: Two Cases of Tumor Lysis Syndrome in Solid Tumors
Abstract: Background: Tumor lysis syndrome (TLS) is in a state of oncologic emergency that may cause sudden death by metabolic abnormalities, acute renal failure. Case 1: A 60-year-old man presented to our hospital with back pain, constipation and loss of appetite and general fatigue. There was history of diabetes mellitus and coronary artery disease. Laboratory findings included elevated calcium to 14.1 mg/dl. A CT scan showed a 8cm mass in size in the pancreatic tail, which was directly invaded to the spleen, left kidney. Multiple liver and lung metastases were also detected. The advanced pancreatic adenocarcinoma was diagnosed by liver needle biopsy, classifing as T4NxM1, cStageIVB. After 2 days of palliative chemotherapy with Gemcitabine + nab-PTX therapy initiation, TLS was developed with elevation of serum potassium and uric acid levels. Although giving fluids for hydration and Glucose-Insulin for hyperkalemia resulted in recovery from TLS, he passed away at 7 days by cancer.Case 2: A 74-year-old man has received laparotomy for advanced mixed adenoneuroendocrine carcinoma after 4 cycles of S-1/CDDP neoadjuvant chemotherapy. Liver metastasis was found after 7 months of operation, admitting to our Department for palliative chemotherapy. Spontaneous TLS developed with elevation of uric acid and AST, accompanying hypercalcemia with bone metastasis. The treatment was initiated with intravenous hydration, febuxostat of xanthine oxidase inhibitor, denosumab of RANKL inhibitor and irradiation 30Gy/10Fr. After 2 weeks of admission, chemotherapy of CDDP+VP16 was started. Grade 4 neutropenic fever, grade 4 DIC appeared as side effects during cycle 1. Despite chemotherapy, his condition deteriorated rapidly, and he passed away at 29 days.Here we report two cases of TLS in solid tumors, which was relatively rare and the most common disease-related emergency, and review previous reports of TLS, including currently advocated guidelines for risk assessment, prophylaxis and management.