allopurinol and Brain-Neoplasms

Topics: Aged; Allopurinol; Antimetabolites, Antineoplastic; Brain Neoplasms; Drug Eruptions; Female; Humans; Lymphoma, B-Cell; Methotrexate; Photosensitivity Disorders; Stevens-Johnson Syndrome; Ultraviolet Rays

Tumor lysis syndrome (TLS) is a potential complication in cancer therapy. It may occur in highly sensitive tumors, especially in childhood cancers and acute leukemias, whereas it is rare in the treatment of adult solid tumors. TLS is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia following massive lysis of malignant cells. Complications include acute renal failure and metabolic acidosis. We report the first case of TLS during chemotherapy in a patient with metastatic medulloblastoma, together with a review of the literature regarding the occurrence of TLS in patients with solid tumors.. Data regarding clinical and biochemical parameters were extracted from the actual patients' files. Reports of TLS in the English language literature up to 2002 were identified by searching Medline.. A 23-year old male with metastatic medulloblastoma received chemotherapy with cisplatin and etoposide due to massive extracerebral manifestations including metastases to the liver, mediastinal lymph nodes and bone marrow metastases. The patient developed classical signs of TLS on the second day of chemotherapy, including acute renal failure. A 17-fold increase in plasma LDH up to 87608 U/l was observed together with a 4-fold increase in plasma creatinine. The patient was treated with aggressive hydration, allopurinol and repeated hemodialysis. During the following days the patient improved and the biochemical markers all returned to normal. REVIEW. Reviewing the literature, a total of 45 patients with solid tumors who developed TLS have been reported. Most of the patients presented with metastatic, therapy-sensitive disease. Although preventable in practically 100% of patients, TLS is a potentially fatal complication, and in this material the mortality rate was one in three. Risk factors included increased LDH, hyperuricemia and pretreatment azotemia.. TLS is only rarely associated with treatment of solid tumors. Precautions should be taken to avoid this potentially fatal complication in (chemo)therapy of solid tumors, especially in therapy-sensitive tumors presenting with bulky, metastatic disease and preexisting risk factors, including azotemia, elevated LDH and hyperuricemia. Prophylactic treatment to avoid TLS includes allopurinol, hydration prior to treatment and alkalization of the urine. Urate oxidase (rasburicase) is now beginning to replace allopurinol as a more effective way of reducing hyperuricemia and thereby the risk of TLS.

Topics: Adult; Allopurinol; Antimetabolites; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Brain Neoplasms; Cisplatin; Etoposide; Fluid Therapy; Humans; Liver Neoplasms; Male; Medulloblastoma; Renal Dialysis; Tumor Lysis Syndrome

Topics: Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Astrocytoma; Biopsy, Needle; Brain Neoplasms; Cyclophosphamide; Epirubicin; Fluorouracil; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Parotid Neoplasms

The impairment of the purinergic system, characterized by reduced adenosinergic activity, has been implicated in the neurobiology of aggressive behaviour. Since there are no direct adenosine agonists available for human use, inhibition of purine degradation by allopurinol was conceived as a possible strategy. We report two cases of adults with refractory aggressive behaviour due to a neurological condition (one mainly with self-inflicted behaviour) with dramatic response to therapy with allopurinol, 300 mg/day p.o. These preliminary results reinforce the involvement of the purinergic system in the neurobiology of aggression, warranting further testing of allopurinol as a new treatment for aggressive and self-inflicted behaviours.

Topics: Administration, Oral; Adult; Aggression; Allopurinol; Astrocytoma; Brain Neoplasms; Combined Modality Therapy; Dose-Response Relationship, Drug; Enzyme Inhibitors; Female; Humans; Intellectual Disability; Male; Meningitis; Neurocognitive Disorders; Parietal Lobe; Postoperative Complications; Radiotherapy, Adjuvant; Self-Injurious Behavior

Xanthine oxidase is most recognized for its role as the rate-limiting enzyme in nucleic acid degradation through which all purines are channelled for terminal oxidation. The enzyme serves as a source of oxygen-derived free radicals which induce both cellular injury and edema as well as changes in vascular permeability. In the study we compared xanthine oxidase levels of human brain tumors with normal brain tissues. Statistical evaluation of our results shows significantly higher xanthine oxidase levels in tumoral brain tissues. However, xanthine oxidase has not any significance for the differentiation of tumor types among each others. The oncotypes studied were meningioma and astrocytoma.

Topics: Astrocytoma; Brain; Brain Neoplasms; Humans; Meningeal Neoplasms; Meningioma; Xanthine Oxidase

Topics: Allopurinol; Brain Neoplasms; Fluorouracil; Humans; Male; Oxypurinol; Pyrimidines; Radiotherapy Dosage

Topics: Abdominal Neoplasms; Adolescent; Age Factors; Allopurinol; Antigens, Viral; Arabia; Bone Marrow Diseases; Brain Neoplasms; Burkitt Lymphoma; Child; Child, Preschool; Cyclophosphamide; Drug Therapy, Combination; Ethnicity; Female; Herpesvirus 4, Human; Humans; Israel; Jaw Neoplasms; Lymphoma, Non-Hodgkin; Male; Methotrexate; Prednisone; Vincristine

Topics: Adolescent; Allopurinol; Brain Neoplasms; Burkitt Lymphoma; Child; Child, Preschool; Cyclophosphamide; Cytarabine; Daunorubicin; Dexamethasone; Female; Humans; Hydroxyurea; Male; Methotrexate; Neoplasm Metastasis; Papilledema; Prednisolone; Vincristine

Topics: Abdominal Neoplasms; Adolescent; Allopurinol; Brain Neoplasms; Burkitt Lymphoma; Child; Child, Preschool; Cyclophosphamide; Female; Ghana; Humans; Jaw Neoplasms; Male; Methotrexate; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Neurologic Manifestations; Ovarian Neoplasms; Prognosis; Sex Factors; Time Factors; Vincristine

Topics: Acid Phosphatase; Animals; Brain; Brain Chemistry; Brain Neoplasms; Carcinoma, Ehrlich Tumor; Glucuronidase; Histocytochemistry; Hyaluronoglucosaminidase; L-Lactate Dehydrogenase; Mice; Microscopy, Electron; Neoplasm Transplantation; Nucleosides; Oxidoreductases; Phosphotransferases; Thymidine; Transferases; Uracil; Uridine; Xanthine Oxidase