Zerbib et al reported cases of urgent chemotherapy for control of life-threatening complications of a solid malignancy. The malignancy is typically situated in or next to a key organ. The onset of the complication may be the first manifestation of the malignancy. The authors are from multiple institutions in France.
Mechanisms of life-threatening complications:
(1) compression with or without obstruction (bronchus, artery, vein, hollow viscus, etc)
(2) tissue infiltration
(3) paraneoplastic effect
(4) spontaneous tumor lysis syndrome
Examples:
(1) lung cancer, causing respiratory failure
(2) thymic carcinoma or other mediastinal tumor
(3) breast cancer
The goal of chemotherapy is to shrink the tumor and to reverse its effect.
If this is the initial presentation of the tumor, then a rapid diagnosis is required to optimize the chemotherapy.
Concurrent therapy may include:
(1) stenting
(2) tumor resection
(3) radiation
(4) arterial embolization
Complications of the chemotherapy:
(1) tumor lysis syndrome
(2) toxicity of the chemotherapy agents
The long-term prognosis is poor with a low 1-year survival rate, especially if the malignancy is metastastic.
