Primary Osteosarcoma in Patients Older than 40 Years of Age

Among the 665 patients who registered at our hospital, we reviewed 39 cases of high grade primary osteosarcoma in patients who were older than 40 yr of age. The aim of this study was to determine if a primary osteosarcoma in older patients has different clinical features, and a poorer prognosis than in younger patients. Two evaluations were performed. In the first, an attempt was made to determine the possible prognostic factors such as gender, location, size, alkaline phosphatase, radiological findings, chemotherapy intensity, chemotherapy-induced tumor necrosis, and surgical margin. The second evaluation involved assessment of whether there were any significant clinical differences between older patients and adoles-cents. According to the results, a primary osteosarcoma in older patients did not reveal any significant prognostic variables. A primary osteosarcoma in older patients showed a poorer prognosis due to relatively unusual locations, common abnormal radiological findings, and a poor response to chemotherapy. Therefore, careful attention should be paid to making an accurate diagnosis and new strategies for more effective treatment, including chemotherapy, must to be developed in order to achieve long term survival in older patients with osteosarcoma.

Clinical significance of vascular endothelial growth factor [VEGF] in sera of patients with pediatric malignancies

Angiogenesis is essential for solid tumor growth. It is induced by tumor cells through stimulatory angiogenic peptides, one such peptide is vascular endothelial growth factor [VEGF]. The ultimate aim of the work is to investigate the possible role of VEGF as an early biomolecule involved in the progression of pediatric malignant tumors with high metastatic potential. Forty-five pediatric patients were studied. They included four groups with malignant solid tumors suffering from Ewing's sarcoma, osteosarcoma, neuroblastoma and rhabdomyosarcoma. In addition, a healthy control group including fifteen age and sex matched children was included in the study. Serum VEGF levels were determined by ELISA technique. The level of VEGF was significantly higher in all types of solid tumors compared to normal healthy children. The mean values obtained for patients and controls were 429.44 +/- 258.55 pg/ml and 79.36 +/- 63.81 pg/ml, respectively. No significant difference was detected in the level of VEGF among males and females. Also, no statistically significant difference was detected among the different types of malignant tumors. However, a marked significant difference was elucidated between metastatic and non-metastatic cancer patients, the values recorded were 753.33 +/- 173.64 pg/ml and 267.5 +/- 75.54 pg/ml, respectively [p <0.001]. Furthermore, the results showed that 207 pg/ml of serum level of VEGF is the optimal cutoff value [mean +/- 2 SD of control] with sensitivity of 87% and specificity of 100%. Using the receiver operating characteristic [ROC] curve analysis, the area under the curve [0.917] indicated the validity of using serum VEGF level in the diagnosis of all different types of pediatric malignant solid tumors with high potentiality to metastasis. VEGF is an angiogenic stimulatory peptide. Its serum level colud be a reliable marker in assessing pediatric malignancies with high metastatic potentials

Serum levels of soluble Fas [S-FAS] and soluble intercellular adhesion molecule-1 [S-ICAM-1] in childhood solid tumors: correlation with clinical features and outcome

The levels of s-Fas and s-ICAM-1 conjointly in sera of patients with malignant diseases were evaluated in sera of sixty-two children with solid tumor on admission. They included thirty-four children with non- Hodgkin's lymphoma [NHL], three with Hodgkin's lymphoma [HL], eight with neuroblastoma, four with retinoblastoma, five with osteosarcoma, three with Ewing's sarcoma and five with Wilm's tumor. For comparative purposes, serum samples were obtained from ten healthy children who were comparable in age and sex with the patients. The study revealed significant increase of s-Fas as well as sICAM-1 in children with solid malignant tumors as a whole and irrespective of the pathological type compared with controls. The sensitivities were 100% and 93.5%, respectively. The levels of either s-Fas or sICAM-1 reflected organomegaly and outcome in children with solid tumor as a whole. Moreover, they reflected tumor spread, grade and burden in cases with NHL. Significant positive correlation existed between s-Fas and sICAM-1