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Akuttherapie onkologischer Notfälle

Therapy of oncological emergencies

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Intensivmedizin und Notfallmedizin

Abstract

Malignancies can cause symptoms which need rapid and adequate diagnosis and therapy. Examples are superior vena cava syndrome or malignant pericardial effusions. Paraneoplastic endocrine disorders are rarely responsible for acute emergencies in oncology. Tumor-related hypercalcemia may require rapid treatment. It can be caused by paraneoplastic phenomena or bone metastasis. At times, adverse effects of antineoplastic therapy can present as an emergency requiring rapid and directed therapy. Examples include the tumor lysis syndrome or acute, severe side effects of antineoplastic agents, e. g., allergic reactions to antibody treatment or 5-fluorouracil induced myocardial ischemia. Neutropenic fever is observed more frequently. It is a consequence of impaired antimicrobial defence during drug induced bone marrow suppression. This review summarizes these oncological emergencies and their therapy.

Zusammenfassung

Maligne Erkrankungen können direkt Symptome verursachen, die einer raschen Diagnostik und Therapie bedürfen. Beispiele sind die obere Einflussstauung oder der maligne Perikarderguss. Auch paraneoplastische endokrine Störungen können Ursache eines akuten Notfalls in der Onkologie werden. Die tumorbedingte Hyperkalzämie kann paraneoplastisch, aber auch direkt durch eine Knochenfilialisierung ausgelöst sein. Auch hier muss bei symptomatischen Patienten unverzüglich eine effektive Behandlung eingeleitet werden. Gelegentlich machen Nebenwirkungen der Tumortherapie eine rasche, konsequente Therapie notwendig. Beispiele hierfür sind direkte bedrohliche Nebenwirkungen von Tumortherapeutika wie z. B. allergische Reaktionen auf Zytostatika oder die 5-FU induzierte Myokardischämie. Das Tumorlyse-Syndrom entsteht dagegen meist aus dem Zusammenwirken des endogen bereits erhöhten Zellumsatzes mit dem Zellzerfall bei Beginn der Tumortherapie. Die häufigste Komplikation bei Tumorpatienten ist das Fieber in der Neutropenie als Ausdruck eines Infektes bei einer verminderten Abwehr von Mikroorganismen unter der therapiebedingten Knochenmarkssuppression. Diese Übersicht befasst sich mit diesen onkologischen Notfällen und ihrer Therapie.

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  1. Klinik und Poliklinik für Innere Medizin I und Abteilung für Hämatologie und internistische Onkologie, Klinikum der Universität Regensburg, 93042, Regensburg, Germany

    F. Klebl &  S. W. Krause

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Serie: Die Notfall- und Intensivtherapie bei hämatologischen und onkologischen Erkrankungen Herausgegeben von E. Holler und C. Wrede (Regensburg)

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Klebl, F., Krause, S.W. Akuttherapie onkologischer Notfälle. Intensivmed 44, 74–87 (2007). https://doi.org/10.1007/s00390-007-0750-5

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