Marvin M. Romsdahl

Conservative surgery and postoperative radiotherapy in 300 adults with soft‐tissue sarcomas

From January 1963 through December 1977, 300 adults with soft‐tissue sarcomas were treated by a conservative surgical excision and postoperative radiotherapy. The absolute two‐ and five‐year disease‐free survival rates are 74% (222/300) and 61.3% (103/168), respectively. The five‐year survival rate varies with: (1) anatomic site, e.g., 69.4% (75/108) for extremity lesions vs. 33% (5/15) for abdominal lesions; (2) histopathologic diagnosis, e.g., 86.4% (19/22) for fibrosarcoma vs. 50% (15/30) for neurofibrosarcoma; and (3) stage of the lesion. The overall local recurrence rate was 22.3% (67/300) and 27% (81/300) of the patients developed distant metastases. The incidence of lymph node metastases as an initial site of spread was only 2.7% (8/300); therefore, elective treatment of the regional lymphatics is not indicated. The 6.5% incidence of significant complications in extremities is low and might be further diminished by careful treatment planning. The combination of conservative surgery and postoperative radiation therapy maintains a functional limb in 84.5% (169/200) of patients with extremity lesions. This rate is comparable to the five‐year survival rate attained with radical surgery.

Arterial occlusion of pelvic bone tumors

Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, I aneurysmal bone cyst, I recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and I metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.

Elevation of putrescine and spermidine in sera of patients with solid tumors

Abstract Serum polyamine levels of patients with solid tumors have been analyzed by a modified liquid chromatography method. In this study, putrescine was found to be the best systemic marker for the solid tumors examined. Putrescine values from sera of cancer patients were considerably higher than the corresponding mean values from normal subjects. Spermidine determinations were higher than normal in 75% of sera examined while spermine values were only occasionally elevated. Determination of serum polyamines appear promising as a potential systemic indicator of malignant diseases.

Hypergastrinemia and colorectal carcinogenesis in the rat

Our objective was to determine whether chronic hypergastrinemia enhances chemical induction of rat colorectal cancers. Forty-five rats were randomized to sham operation or antral exclusion. Following a 2-week postoperative recovery period all rats were treated with 1,2-dimethylhydrazine (10 mg/kg) intraperitoneally for 20 weekly doses. Seven weeks later, the rats were killed. Blood was assayed for gastrin by radioimmunoassay. Tumor number, location, size, weight and histology were determined. The 23 rats receiving antral exclusion were hypergastrinemic compared with the 22 sham operated rats. All hypergastrinemic rats developed tumors while only 72.7% of normogastrinemic rats developed tumors. Hypergastrinemia increased the number of tumors/rat, total tumor weight/rat and total tumor volume/rat.

Comparison of effects of pentagastrin and gastrin on rat colon mucosa

The trophic effect of chronic endogenous hypergastrinemia is compared with that of short term injected pentagastrin on colon mucosa of rats. Hypergastrinemia was achieved by antral exclusion. Pentagastrin (2 mg/kg) was administered to a group of sham operated rats every 12 hr for 48 hr prior to sacrifice. Normogastrinemic antrectomized and sham operated animals were studied as controls. Tissue content and synthesis of DNA, RNA, and protein were all markedly increased by both endogenous gastrin and exogenous pentagastrin. The stimulation by gastrin was significantly stronger than that of pentagastrin at the chosen schedule of administration.

Preliminary longitudinal studies of serum polyamines in patients with colorectal carcinoma

Polyamines, whose biosynthesis is a prerequisite for cell proliferation, are potential indicators of malignant growth. In view of this, serum polyamine levels were examined in longitudinal studies of patients with either colorectal carcinoma or Gardners syndrome (inherited colonic polyposis possessing a potential for malignant degeneration). Of 10 patients examined longer than one year, serum polyamine levels reflected the disease status. This study indicates that biochemical surveillance of patients by polyamine analysis may be feasible and possibly applicable to other types of tumors.

Open Biopsy of Sarcomas

While all aspects of the clinical management of patients with musculoskeletal neoplasms are important to obtain the most favorable outcome, establishing the correct pathological diagnosis by a biopsy procedure is of paramount importance. One must acknowledge, however, that evaluation of such patients includes other important considerations, with biopsy ideally following an orderly plan of clinical and diagnostic examinations.