Investigation of carbohydrate metabolism and somatomedin in osteosarcoma patients

Osteosarcoma in young children

The clinicopathologic features of osteosarcoma in 12 children younger than 16 years of age treated at The Children's Hospital and Dana-Farber Cancer Institute, Boston, during a 70-year time period are presented. Only one of six children treated before 1972 is a long-term survivor. Four of six children (67%) treated after 1972 are disease-free with an average follow-up of 8.8 years. The year 1972 marked the onset of use of effective chemotherapy in osteosarcoma, namely, high-dose methotrexate and leucovorin rescue. It would appear that the pathologic features and behavior of osteosarcoma in young children is similar to that of osteosarcoma in older children and adolescents. A combination of complete (wide) surgical resection or amputation and aggressive chemotherapy offers the best chance of long-term survival.

Hormonal evaluation in patients with osteosarcoma

Aspects of growth regulation were studied in patients with osteosarcoma to ascertain if hormonal imbalance is associated with this disease. Thirty-nine evaluated patients were of normal height for their ages. During the oral glucose tolerance test, carbohydrate intolerance was demonstrated in seven of 18 patients, while growth hormone was slightly elevated in four of 17 patients. Serum somatomedin activity (SMA) was elevated in seven of nine patients. In one untreated patient in whom SMA was measured across the tumor bed, significant gradient of SMA was found; gel filtration of the sera at pH 2.4 revealed a typical SMA profile in the arterial serum and an additional high SMA peak in the venous serum. Among needle biopsy specimens incubated for 48 hours, SMA was released by the histologically viable tumors but not by the nonviable specimens. The data suggest that young patients with osteosarcoma have elevated SMA.

Paraneoplastic syndromes with soft-tissue sarcoma: a report of two unusual cases

Paraneoplastic syndromes secondary to mesodermal tumors are relatively uncommon. In this report, we describe two unusual cases associated with soft-tissue sarcoma: a 69-year-old male who had a normochromic anemia, without apparent etiology, that resolved promptly after surgical resection of the primary tumor; and a 22-year-old female with hypercalcemia without evidence of bony destruction.

In vivo utilization of substrate by human sarcoma-bearing limbs

Human sarcoma-bearing limb substrate utilization was characterized by studying 10 otherwise healthy patients with extremity sarcomas (five osteosarcomas, five soft tissue sarcomas). All patients were studied in the postabsorptive state. Extremity blood flow was measured using a non-invasive capacitance plethysmograph. Percutaneous arterial and venous effluent blood samples from the tumor-bearing (TB) and control extremity were obtained and flux was calculated for free fatty acids (FFA), glucose, and amino acids. The control limb showed a release of amino acids similar to that reported previously. There was a dramatic difference in the TB extremity, which consistently released fewer amino acids. Both the TB and control limbs released FFA at the same rate. A significant difference in glucose uptake between TB and control limbs was noted for soft tissue sarcoma patients but not osteogenic sarcoma patients. The amount extracted correlated with excised tumor size and gluconeogenic amino acid release from the contralateral normal limb. This study suggests that the tumor-bearing limb ignores the inherent conservation mechanisms in the postabsorptive state and continues to utilize substrate, apparently at the expense of host tissues.

Metabolic and endocrine alterations in osteosarcoma patients

Eighteen patients with primary osteosarcoma were studied for abnormal endocrinologic functions. Oral glucose tolerance tests revealed abnormal glucose, insulin, or growth hormone response curves in 78% of the study population. Elevated somatomedin values were noted in 72% of the patients tested. No significant deviations were observed in serum cortisol, estradiol, testosterone, follicle stimulating hormone, and luteinizing hormone levels. Likewise, lipid screening and 24 hour 17-hydroxy and 17-keto steroid excretion levels were normal. Statistically these derangements were unrelated, leading to the hypothesis that some additional factor or factors are present and responsible for the abnormalities noted. These deviations, found in association with primary osteosarcoma, constitute a new "paraneoplastic syndrome."