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Cisplatin-based combination chemotherapy is regarded as standard of care for patients with advanced germ cell tumors. In patients with lung metastases and a high tumor load, an association between induction chemotherapy and the development of a 'tumorassociated' acute respiratory distress syndrome (ARDS) has been hypothesized.
We report the clinica...
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... required a maximally in- vasive mechanical ventilation (positive end-expiratory pressure (PEEP) levels up to 22 cm H 2 O, F i O 2 100%) in order to achieve a p a O 2 > 60 mm Hg. Clinically, the diagnosis of an ARDS was made although the typical radiological signs of ARDS were not present, most probably due to the pre-existing lung metastases ( fig. 2). The patient showed no signs of sepsis (low procalcitonin levels, normal coagulation parameters, no severe im- pairment in renal and hepatic function); thus, an extrapulmonary etiology for the ARDS was rather unlikely. A ventilator-associated pneumonia was ruled out due to negative microbiological findings on broncho-alveo- lar lavage. ...
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... Among those patients with poor prognosis GCTs, there is a subset of patients with metastatic GCTs who develop rapidly progressive respiratory failure and die early during the course of treatment [6]. These patients usually have extensive lung metastases and very high levels of serum human chorionic gonadotropin (hCG) at presentation [3,7]. It has been postulated that the underlying mechanism of this syndrome is massive cell death due to chemotherapy and consecutive release of cytokines, potentially aggravated by alveolar hemorrhage [3,4]. ...
... The release of the intracellular substances is considered to be the cause of this syndrome. Furthermore, the release of cytokines can also cause a systemic inflammatory response that sometimes leads to multiple organ failure [7][8][9]. ...
... In our extensive search of the related clinical publications, we only found a few case reports [2][3][4]7] and small retrospective case series, which described the association of systemic chemotherapy and ARDS in metastatic GCT [5,6]. The association between the development of ARDS and systemic chemotherapy in GCT was identified in the early 1980s [10]. ...
Germ cell tumors (GCTs) are one of the more curable solid cancers in men. Approximately 8500 men are diagnosed with GCTs in the USA. The majority of patients survive due to the availability of effective treatment. Fewer than 400 men are estimated to die from their disease. Among those, there is a subset of patients with metastatic GCTs receiving chemotherapy who rapidly develop progressive respiratory failure and die during the early phase of their treatment course. In this review, we searched the available literature for reported cases and retrospective series of chemotherapy-associated acute respiratory distress syndrome in GCTs. We aim to determine whether a different approach from current treatment guidelines could be considered to prevent this catastrophic chemotherapy-related event.
... such as docetaxel, trastuzumab, lapatinib, gemcitabine, cisplatin, busulfan/melphalan, bleomycin, and so forth, seem to be associated with the development of a severe pneumonitis leading to ARDS even though it represents a very rare side effect2021222324252627282930. The patient presented in this case report received docetaxel , trastuzumab, as well as lapatinib; accordingly the patient was treated with potential pneumonitis inducing agents. ...
Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.
In the present update, the authors review the current state of the art in cancer. Epidemiology of the neoplastic disease is reviewed considering the incidence and prevalence of the different and most frequent types of cancer as well as their mortality rates. Moreover, comments of costs and prevention have been reviewed. A second part of this chapter is the review of the causes of cancer. The aetiology of the neoplastic processes is developed, taking into account the environmental factors such as industrial environment, ultra-light and irradiation, cigarette smoking and the effects of diet. The authors also review the action of drugs, hereditary factors, oncogenes and viruses. Finally, an exhaustive review of the different therapeutic strategies including chemotherapy, radiotherapy, and other new treatments such as gene therapy, hormone therapy, targeted therapy or immunotherapy are discussed
