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Communication Dans Un Congrès Année : 2017

Urgent chemotherapy for life-threatening complications related to solid neoplasms

Yoann Zerbib
  • Fonction : Auteur
Antoine Rabbat
  • Fonction : Auteur
Muriel Fartoukh
  • Fonction : Auteur
Naïke Bigé
  • Fonction : Auteur
Julien Mayaux
  • Fonction : Auteur
Nicolas De Prost
Benoit Misset
  • Fonction : Auteur
Virginie Lemiale
  • Fonction : Auteur
Fabrice Bruneel
  • Fonction : Auteur
Sylvie Ricome
  • Fonction : Auteur
Frédéric Jacobs
  • Fonction : Auteur
Caroline Bornstain
  • Fonction : Auteur
François Baudin
  • Fonction : Auteur
Elie Azoulay
Frédéric Pène
  • Fonction : Auteur

Résumé

Introduction Both haematological and solid malignancies may be directly responsible for life-threatening organ failures including obstruction of anatomical structures, tissue infiltration, tumor lysis syndrome, or coagulation disorders. Besides advanced life support and eventual instrumental interventions, the treatment of cancer-related organ failures relies on timely administration of chemotherapy. Published data about requirements of chemotherapy in the ICU are mostly related to patients with haematological malignancies, while reports of patients with solid tumors are scarce. In this study, we addressed the features and outcomes of patients with organ failures directly related to solid neoplasms. Patients and methods We performed a retrospective multicenter study within the GrrrOH research network. All adult patients who were admitted to the ICU with organ failures related to solid malignancies and treated with chemotherapy between 2000 and 2015 were enrolled into the study. Data were collected from individual files, and included the overall severity through the SOFA score computed at the time of ICU admission, the type and mechanism of organ failures, and the modalities of chemotherapy administration. Endpoints were the in-ICU and in-hospital vital status. Results 136 patients were included. The most common underlying malignancy was lung cancer (n = 90), distributed between small cell lung cancer (SCLC) (n = 57) and non-small cell lung cancer (NSCLC) (n = 33). Most malignancies were newly diagnosed (n = 122, 89.7%), the diagnosis being made in the ICU for 80 patients (58.9%). The majority of patients (n = 82, 60.3%) had metastasis. The main reason for ICU admission was acute respiratory failure in 111 (81.6%) patients. Compression and tissue infiltration by tumor cells were the leading mechanisms resulting in organ involvement in 78 (57.4%) and 47 (34.6%) patients. Other indications for ICU admission relied on paraneoplastic manifestations in 11 cases. The treatment was based on combined and single chemotherapy in 120 (88.2%) and 16 (11.8%) patients, respectively. The dosing was reduced in 20 patients (20%) mostly linked to renal failure, and the sequence of drug administration was modified in 18 patients (18%). Thirty-four patients (25%) required either instrumental or surgical adjuvant procedures. Eighty-nine patients received invasive mechanical ventilation with duration of 13 (5–25) days, 39 patients required vasopressors (28.7%) and 11 required renal replacement therapy (8.1%). The overall in-ICU, in-hospital, 6-month and 1-year mortality rates were 37, 58, 74 and 88%, respectively. In a multivariate logistic regression analysis, SCLC was identified as an independent predictor of hospital survival. However this gain in survival was not sustained since the 1-year survival rates of SCLC, NSCLC and non-lung cancer patients all dropped below 20%. Discussion The prognosis of solid neoplasm-related organ failures relies on multidisciplinary management involving both intensivists and oncologists. Appropriate management of cytostatic drugs is paramount to improve their efficacy on tumor cells while minimizing their toxicity. Dosing of chemotherapy in critically ill patients represents a still unexplored area of research owing to a number of factors that may result in drug underdosing or overdosing. Conclusion Acute respiratory failure related to lung cancer represents the main indication for urgent administration of chemotherapy in the ICU. Urgent chemotherapy along with aggressive management of organ failures in the ICU can be life-saving in a number of cancer patients, most especially for SCLC, although the long-term survival is hardly sustainable.
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Dates et versions

hal-03967020 , version 1 (01-02-2023)

Identifiants

  • HAL Id : hal-03967020 , version 1

Citer

Yoann Zerbib, Antoine Rabbat, Muriel Fartoukh, Naïke Bigé, Claire Andrejak, et al.. Urgent chemotherapy for life-threatening complications related to solid neoplasms. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress, Jan 2017, Paris, France. pp.P133. ⟨hal-03967020⟩
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