Journal of Clinical Oncology, Vol 4, 1191-1198, Copyright © 1986 by American Society of Clinical Oncology
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in small-cell lung cancer
AF List, JD Hainsworth, BW Davis, KR Hande, FA Greco and DH Johnson
Review of clinical data from 350 patients with small-cell lung cancer
(SCLC) revealed hyponatremia (sodium less than 130 mEq/L) attributable to
the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in
40 patients (11%). Although hyponatremia was severe in most instances
(median, sodium 117 mEq/L), symptoms attributable to water intoxication
were identified in only 27% of hyponatremic episodes. Development of SIADH
showed no correlation with clinical stage, distribution of metastatic
sites, sex, or histologic subtype of small- cell carcinoma. SIADH occurred
most often with initial presentation (33 of 40), and resolved promptly
(less than 3 weeks) with initiation of combination chemotherapy in 80% of
evaluable patients. The presence of SIADH did not influence response to
chemotherapy or overall survival as an independent variable. However, in
five patients profound hyponatremia developed immediately following primary
cytotoxic therapy (range, one to five days). Despite initial control of
SIADH, dilutional hyponatremia recurred in 70% of patients with tumor
progression. Our findings suggest that development of clinically
demonstrable SIADH in patients with SCLC is dependent on functional
properties of the neoplastic cells, rather than tumor burden or metastatic
site. The potential for development of clinically significant hyponatremia
early in the course of cytotoxic therapy emphasizes the need to closely
monitor patients, particularly those receiving chemotherapy regimens
requiring substantial intravenous hydration.
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