Specialization Program in Internal Medicine, School of Health, Universidad Santiago de Cali, Santiago de Cali, Colombia; Research and Education Department, Clínica de Occidente S.A., Santiago de Cali, Colombia; Genetics Physiology and Metabolism Research Group (GEFIME), Universidad Santiago de Cali, Santiago de Cali, Colombia.
Specialization Program in Internal Medicine, School of Health, Universidad Santiago de Cali, Santiago de Cali, Colombia.
Chin Clin Oncol. 2023 Aug;12(4):45. doi: 10.21037/cco-22-111. Epub 2023 Aug 14.
Tumor lysis syndrome (TLS) is recognized as an oncologic disorder with a variable incidence. TLS can cause the rapid destruction of tumor cells in response to oncologic therapy and is characterized by multiple electrolyte disturbances as well as its secondary complications, including death. This disease is common among patients with hematologic neoplasms, but very rare among those with solid tumors, as is the case with sarcomas. Such patients have a poor prognosis and increased risk of mortality. In the patient's particular case, this occurred after initiating third-line systemic therapy with gemcitabine associated with pazopanib, an event not previously described in the literature.
We report the case of a patient with a history of high-grade sarcoma of the left lower limb T4N1M0 stage IIIB undergoing surgical management and exhibiting tumor progression with the need for third-line systemic therapy with pazopanib and gemcitabine. The patient presented with pain at the amputation site, inflammatory changes, and a tumor mass of large components on admission. They later developed electrolyte imbalance and acute renal injury compatible with TLS after systemic therapy was initiated. Pharmacological therapy, including rasburicase, was initiated based on the clinical and laboratory findings. Due to the progression of renal involvement, it was necessary to initiate haemodialysis, and during her hospital stay, the patient presented febrile syndrome associated with pancytopenia. The patient showed a favourable clinical response to the proposed antibiotic therapy and recovery of renal function, for which reason therapy was restarted with pazopanib and gemcitabine, the latter with a 20% reduction for the following cycles. Outpatient follow-up continued, completing eight cycles of treatment with good tolerance and partial clinical response; the patient died of respiratory complications eight months after discharge.
There is limited evidence for TLS in patients with high-grade sarcoma in the literature related to the oncologic therapy used; this indicates that early risk evaluation along with prompt initiation of effective therapies is required to prevent the appearance of this type of complications in the short and long term.
肿瘤溶解综合征（TLS）是一种肿瘤相关的疾病，其发病率不一。TLS 可导致肿瘤细胞在接受肿瘤治疗后迅速破坏，并伴有多种电解质紊乱及其继发并发症，包括死亡。这种疾病在血液系统恶性肿瘤患者中较为常见，但在实体瘤患者中非常罕见，肉瘤就是如此。此类患者预后较差，死亡率较高。在该患者的特殊情况下，在开始接受吉西他滨联合帕唑帕尼的三线系统治疗后发生了这种情况，这在文献中尚未有过描述。
我们报告了一例左下肢高级别肉瘤患者的病例，该患者处于 IIIB 期 T4N1M0 期，接受了手术治疗，并且在需要接受三线系统治疗时出现了肿瘤进展，治疗方案为帕唑帕尼和吉西他滨。患者入院时出现截肢部位疼痛、炎症改变和大块肿瘤，随后在开始系统治疗后出现电解质失衡和急性肾损伤，符合 TLS 表现。根据临床和实验室发现，开始使用拉布立酶等药物进行药理治疗。由于肾脏受累进展，需要开始血液透析，在住院期间，患者出现发热伴全血细胞减少的综合征。患者对所提议的抗生素治疗和肾功能恢复表现出良好的临床反应，因此重新开始使用帕唑帕尼和吉西他滨治疗，后者在接下来的周期中减少 20%。继续进行门诊随访，完成了 8 个周期的治疗，耐受性良好，部分临床反应；患者在出院后 8 个月因呼吸并发症死亡。
文献中与所用肿瘤治疗相关的高级别肉瘤患者的 TLS 证据有限；这表明需要进行早期风险评估并及时开始有效的治疗，以预防此类并发症在短期和长期内出现。
