Kano Yuta, Muranaka Tetsuhito, Saito Wataru, Honma Yusuke, Yokoyama Daisuke, Otsuka Yutaro, Matsuda Soichiro, Takishin Yunosuke, Kunieda Yasuyuki
Internal Medicine, Wakkanai City Hospital, Wakkanai, JPN.
Cureus. 2025 May 27;17(5):e84896. doi: 10.7759/cureus.84896. eCollection 2025 May.
Tumor lysis syndrome (TLS) is an oncologic emergency characterized by massive tumor cell lysis accompanied by the excessive release of large amounts of intracellular electrolytes and metabolites into the bloodstream. TLS is a potentially life-threatening condition that can lead to acute kidney injury, seizures, and sudden death due to arrhythmias. Therefore, prophylactic measures and prompt therapeutic intervention are essential for its management. TLS in solid tumors is extremely rare and has been documented only in a limited number of case reports. To our knowledge, three previous cases of TLS with colorectal cancer undergoing chemotherapy have been reported in the literature. We successfully treated a patient who developed TLS following modified FOLFOX6 (mFOLFOX6) therapy. The patient had ascending colon cancer with liver metastasis and right ureteral invasion and underwent colostomy before the initiation of mFOLFOX6. The presence of liver metastasis and elevated lactate dehydrogenase (LDH) levels on pre-treatment blood tests was considered a risk factor for the development of TLS. Therefore, blood tests were performed on day three after the initiation of mFOLFOX6 therapy, which revealed the onset of TLS. Prompt treatment with intravenous hydration, administration of diuretics, and oral febuxostat led to rapid improvement in serum uric acid, potassium levels, and renal function, allowing successful management without progression to a severe situation. This case further emphasizes that early identification and treatment of TLS are critical for the prevention of irreversible organ damage. Although TLS does not present with specific clinical symptoms, this case highlights the importance of close monitoring through blood tests even after the initiation of chemotherapy in patients with solid tumors who are at risk for TLS. Particularly in tumors with known risk factors for TLS, it is essential to perform blood tests by the third day after the initiation of chemotherapy to assess for the development of TLS.
肿瘤溶解综合征（TLS）是一种肿瘤急症，其特征为大量肿瘤细胞溶解，同时伴有大量细胞内电解质和代谢产物过度释放进入血液。TLS是一种潜在的危及生命的疾病，可导致急性肾损伤、癫痫发作以及因心律失常而猝死。因此，预防性措施和及时的治疗干预对其管理至关重要。实体瘤中的TLS极为罕见，仅有少数病例报告记载。据我们所知，此前文献中报道过3例接受化疗的结直肠癌患者发生TLS。我们成功治疗了一名在改良FOLFOX6（mFOLFOX6）治疗后发生TLS的患者。该患者患有升结肠癌伴肝转移及右输尿管侵犯，在开始mFOLFOX6治疗前接受了结肠造口术。治疗前血液检查发现存在肝转移以及乳酸脱氢酶（LDH）水平升高被认为是发生TLS的危险因素。因此，在mFOLFOX6治疗开始后第3天进行了血液检查，结果显示发生了TLS。通过静脉补液、给予利尿剂和口服非布司他进行及时治疗，使血清尿酸、钾水平和肾功能迅速改善，得以成功管理病情，未进展至严重情况。该病例进一步强调，早期识别和治疗TLS对于预防不可逆的器官损伤至关重要。尽管TLS没有特定的临床症状，但该病例突出了对于有TLS风险的实体瘤患者，即使在化疗开始后也通过血液检查进行密切监测的重要性。特别是在已知有TLS危险因素的肿瘤中，在化疗开始后第3天进行血液检查以评估TLS的发生至关重要。
