Successful treatment of acute tumor lysis syndrome associated with transcatheter chemoembolization with large hepatocellular carcinomas: two case reports

Tumor lysis syndrome (TLS) is a potentially lethal complication of cancer therapy, and mostly in patients suffering from hematological disease. Acute TLS is a rare complication in the treatment of solid organ tumors, such as hepatocellular carcinoma (HCC), since the cancer cells of these organs are generally considered to be insensitive to tumor therapy. However, the mortality of acute TLS of solid organs is higher than that of malignant tumors of the blood system. One such reasons is due to the lack of understanding of TLS in solid organs. This study presents two cases of large HCC treated via conventional transarterial chemoembolization (cTACE) and drug-eluting beads transarterial chemoembolization (DEB-TACE), respectively, that developed TLS. The patient developed symptoms of high fever and renal insufficiency following TACE. The diagnosis was confirmed according to the Cairo-Bishop criteria. Fortunately, both patients recovered and were discharged with rehydration, diuresis and timely dialysis. The tumor necrosis rate was higher after DEB-TACE and as TLS may occur more frequently with the increasing application of DEB-TACE, clinicians should pay more attention to it. TLS is a very rare and easily neglected complication that may occur following TACE, which is easily confused with contrast-induced acute renal failure. Appropriate preventive measures should be given to the patient who with high risk factors for TLS. Furthermore, during treatment, the use of Fasturtec may have also played a certain role in the treatment’s efficacy. Dialysis should be carried out as soon as the patients were oliguric, which may serve as the most important factor in saving the patient’s life. Clinical practice has proven that early recognition and treatment can reduce mortality rates due to TLS. This study provides additional references for the management of complications that occur after TACE, thereby improving the clinical outcomes of patients.