Introduction
Vigorous hydration is often used prior to, during or after the administration of some cytotoxic drugs. In some cases this is to prevent Tumour Lysis Syndrome but in others it is to reduce the toxicity of the cytotoxic drugs.
Which PatientsTumour Lysis Syndrome
Tumour lysis syndrome (TLS) can occur after effective systemic chemotherapy for rapidly growing, bulky, chemosensitive tumours.
Rapid tumour lysis results in the release of intracellular uric acid, phosphate and potassium, which causes hyperuricaemia, hypocalcaemia, hyperkalaemia and hyperphosphataemia.
Without effective treatment, renal failure occurs rapidly from uric acid nephropathy and calcium-phosphate deposition in the renal tubules. Patients with preexisting renal dysfunction are more likely to be at risk.
TLS occurs 1-5 days following the initiation of effective chemotherapy.
The tumours most commonly associated with TLS are:
- Acute lymphoblastic leukaemia and lymphoma
- Burkitt's lymphoma
- Rapidly growing diffuse undifferentiated lymphomas
TLS is much less likely to occur in solid tumours as rapid tumour regression is uncommon.
Treatment should be preventative.
Patients should be pretreated with allopurinol and adequately hydrated at least one day pre- and for 3-5 days post- chemotherapy.
Potassium, calcium, phosphate, creatinine and uric acid should be measured regularly (initially every six hours).
Heamodialysis support may be necessary for patients who develop renal failure.
References
- Manual of Oncologic Therapeutics, Third Edition
MacDonald J, Haller D, Mayer R - Supportive Care File
Dept of Paediatric Oncology
Royal Marsden NHS Trust
Which Patients Require Hydration?
Hydration is used for patients receiving:
- Cisplatin
- Cyclophosphamide (high doses)
- Ifosfamide
- Methotrexate (high doses)
- Melphalan