Tumor Lysis Syndrome
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Tumor lysis syndrome is an oncological emergency. The massive turnover of tumor cells leads to accumulation of electrolytes and uric acid that could lead to renal failure and cardiac arrhythmias. There are clinical and laboratory classifications of tumor lysis syndrome, and several risk stratification models have been proposed. Prevention of tumor lysis syndrome involves intravenous hydration and administration of hypouricemic agents. Rasburicase is preferred over allopurinol in high risk cases. Urinary alkalization in prevention is controversial. Treatment of tumor lysis syndrome includes intensive monitoring of renal function, fluid balance and electrolytes. Neuromuscular irritability manifesting as cardiac arrhythmias and seizures is a significant concern. Prevention of cardiac arrhythmias is done by appropriately managing hyperkalemia and hypocalcemia. Despite aggressive preventive measures, renal failure develops in some patients requiring initiation of renal replacement therapy. Pre-phase treatment with low intensity chemotherapy has been a strategy that is being used frequently in certain forms of cancer to reduce the development of tumor lysis syndrome. Certain aspects of management of tumor lysis syndrome remain controversial.
KeywordsTumor lysis syndrome Rasburicase Allopurinol Renal failure Urinary alkalization Renal replacement therapy Treatment prephase Phosphate binders Intravenous diuretics
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