Terapêutica da hipercalcemia em neoplasias sólidas - Análise retrospectiva num serviço de Medicina Interna

Abstract

The authors present a retrospective study on the therapy of hypercalcemia used in patients with solid neoplasms, hospitalized in Medicine II Service of HUC. 171 patients were submitted to stu­dy, 45 (26,3%) of which had hypercalcemia ( cal­cium :::,_10,4 mg/ d ajter correction by albuminemia). ln the cases were analised used therapies, optio­nal criterions (level of calcemia, symptomatology, bone metastization), obtained response and relati­ on with the therapy of the solid neoplasm. From the obtained results they underline: A) The therapi­ es used were: hydratation only (n = 27) and associ­ ated with drugs (n = 18), include always furosemi­de), {corticoids ( n = 6), calcitonin ( n = 9), bisphos­ phonates (n = 12)}. B) ln the 10 patients with se­ rious hypercalcemia (:::,_ 13 mgldl) all made thera­ peutic associations, while only 6 ofthe 29 with sli­ght hypercalcemia (:::,_ 10,4 - 11,5 mgldl) used them ln the patients with serious symptoms (n = 14) at­ tributed to hypercalcemia, only 7 made associati­ ons beyond hydration. ln the patients with documented bone metastization ( n = 15) predominated the use of calcitonin or bisphosphonates. C) The regression of the symptomatology was more consi­derable in the group that used bisphosphonates. ln the patients subjected to the therapy, there was temporary control of calcemia, more relevant with various drugs in association. ln a third of the pati­ents that used bisphosphonates or calcitonin there was an ease of pain. D) The death rate in hospitali­zation and delay was about twice more than the total of the hospitalized patients.

Conclusions: 1) Significant predominance of the metabolic disturbance (26%) in the solid neoplasms.

2) The hypercalcemia was valorized being subjec­ted to the therapeutic measures besides the hydra­tion 40% of the patients. 3) The therapeuic option was more specifically based on the leveis of calce­mia rather than on the symptoms, and the bone metastization influenced the use of calcitonin and bisphosphonates. 4) The symptomatic improvement in a significant number of patients and the tempo­ rary control of the leveis of calcium, are factors which improved the quality of life of these patients, counter balacing them until measures of basis are adopted, what occurred in a third ofthe cases.