Tumor Lysis Syndrome in a Patient With Metastatic Endometrial Cancer Treated With Lattice Stereotactic Body Radiation Therapy

Joshua P Schiff,Matthew B Spraker,Sai Duriseti,Sana Shaikh,Haris F Murad,David G Mutch,Clifford G Robinson,James Kavanaugh,Alexander J Lin

doi:10.1016/j.adro.2021.100797

Joshua P Schiff, Matthew B Spraker + Show 7 more

Open Access

https://doi.org/10.1016/j.adro.2021.100797

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Abstract

Tumor Lysis Syndrome in a Patient With Metastatic Endometrial Cancer Treated With Lattice Stereotactic Body Radiation Therapy

Highlights

IntroductionTumor lysis syndrome (TLS) is comprised of a combination of metabolic abnormalities and acute kidney injury that usually occurs in patients with hematologic malignancies undergoing cytotoxic treatment.[11−14] toTumor lysis syndrome (TLS) is rare in patients with solid tumors, especially those treated with radiation therapy in the absence of chemotherapy, a few prior cases have been reported.[12,13] Here we describe a case of TLS in a patient with metastatic endometrial clear cell carcinoma treated with lattice stereotactic body radiation therapy (SBRT) alone
Fractionated radiation therapy is hypothesized to allow for safe, hypofractionated, dose- escalated radiation therapy for large tumors.[1,2,3] Spatially fractionated radiation therapy can be delivered in a grid-like pattern using 3-dimensional conformal planning techniques
Lattice delivers a low dose to a gross tumor volume (GTV) with high dose spherical vertices spaced within the tumor, which has previously been described in small case series of patients with gynecologic and other malignancies.[4−8] We recently developed a spatially fractionated lattice stereotactic body radiation therapy (SBRT) technique that simultaneously delivers 20 Gy in 5 fractions to Sources of support: This work had no specific funding

Summary

Introduction

Tumor lysis syndrome (TLS) is comprised of a combination of metabolic abnormalities and acute kidney injury that usually occurs in patients with hematologic malignancies undergoing cytotoxic treatment.[11−14] TLS is rare in patients with solid tumors, especially those treated with radiation therapy in the absence of chemotherapy, a few prior cases have been reported.[12,13] Here we describe a case of TLS in a patient with metastatic endometrial clear cell carcinoma treated with lattice SBRT alone. The patient was deemed not to be a surgical candidate and so was referred to radiation oncology for palliative radiation therapy Given her pain and bleeding, the patient was offered palliative radiation to the pelvis 20 Gy in 5 fractions or further dose escalation with lattice SBRT on a phase II clinical trial (NCT04553471). The patient tolerated treatment well with only grade 1 nausea, diarrhea, and fatigue, which were present before initiating lattice SBRT She was seen in a scheduled follow-up visit 4 days after the completion of therapy. Panels (D-F) demonstrate the lattice stereotactic body radiation therapy (SBRT) plan, with the characteristic high dose spherical vertices spaced uniformly within the gross tumor volume (GTV)_2000 (red).

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