Introduction. Bone tumors of the pelvic ring often have a poor prognosis because of late diagnosis and difficult treatment. The treatment of pelvic sarcoma poses a huge surgical challenge for reconstruction. Purpose. To assess the surgical technic and early results using patient specific 3D-printed implants for reconstruction of pelvic ring. Materials and Methods. Twenty patients with primary bone tumors involving pelvic bones were treated with personalized 3D-printed prosthesis after enbloc resection between 2018 and 2019. The study included 12 male and 8 female, age range 26-66, mean age was 47 years. Most frequent indications for surgical treatment were chondrosarcoma and osteosarcoma of pelvic bones. Functional results were estimated by MSTS scoring system. All resections were performed with patient specific instrumentation. In 18 cases acetabulum and hip joint reconstructions were necessary. Results. The mean surgical time was 7 hours and bloodloss was 2500ml. The mean follow-up was 6 months, from 1 to 16 months. In 9 cases with primary surgery and reconstruction were clear surgical margin and one case was R1. MSTS functional score of patients was mean 19 points and ranged from 0 to 29 points. All patient specific 3D-printed implants were available within mean 12 days (from 7 to 21 days) after the formal order. Conclusion. Pelvic bone defect reconstruction following tumor resection using 3Dprinted implants can obtain acceptable oncological and functional results. This study has the following limitations: short followup period and small cohort of patients. However, we believe that reconstruction with 3D-printed implants will provide acceptable result.

Objective. To study the influence of the degree of sclerosis in the retroperitoneal well-differentiated liposarcomas (WDLPS) on the long-term results of surgical treatment of patients. Material and methods. The study included 111 patients with primary retroperitoneal WDLPS who underwent radical surgical treatment in Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Health of the Russian Federation. Histological slides of all surgical specimens were reviewed by an experienced pathologist and reclassified according to WHO criteria (2013) for histological subtypes of the WDLPS. Patients were divided into groups depending on the degree of tumor sclerosis and enrolled in intergroup analysis of overall (OS) and recurrencefree (RFS) survival was performed. Results. OS is significantly worse in the group of patients who had the degree of sclerosis in the tumor >15% (p=0.0001; log-rank test). The median OS was 221 months (95% CI, 176, 265) in the group of lipoma-like subtype (sclerosis <15%), and 115 months (95% CI, 90, 140) in the group of sclerosing subtype (sclerosis >15%). The 10-year survival rates were 50% and 18% in the lipoma-like and sclerosing subtype groups respectively. RFS was also significantly worse in the group of patients with the sclerosing subtype of the WDLPS than in the group of patients with the lipoma-like subtype (p=0.001; log-rank test). The median RFS was 83 months (95% CI, 76, 90) in the lipoma-like subtype group, and 42 months (95% CI, 35, 49) in the sclerotic group. The 5-year RFS were 54% and 21% in the groups of lipoma-like and sclerosing subtypes respectively. Conclusion. Results of the study demonstrate that increased amount of sclerosing component in the WDLPS is associated with poor prognosis. We believe that semi-quantitative counting of sclerosing component in retroperitoneal WDLPS can serve as an effective morphological marker of a less favorable prognosis of the disease.

Soft tissue sarcomas (STS) are rare malignant neoplasms, in the treatment of which a multimodal approach is used. Radiation therapy (RT), chemotherapy (CT), surgical treatment, including interventional radiology (IR) techniques are actively used. In spite of a certain success in the treatment, there is a number of problems to be solved. In order to solve them, thebi methods of treatment introduced due to IR development are studied. Every year the number ofX-surgery interventions performed worldwide is increasing more than 10%. The analysis of data on application of intra-arterial chemoinfusion, embolization and chemoembolization is carried out and our own intra-arterial chemoinfusion experience in the treatment of STS patients has been described.

Metastasis of malignant tumors to the spine is a common problem in cancer patients and occurs through the hematogenous route. The main symptoms of spinal metastases are pain and neurological disorders. Modern imaging methods make it possible to verify tumor metastases. Indications for surgical treatments are determined with the help of prognostic scales, which also can help predict the treatment results. The optimal treatment is the combination of surgical treatment and radiation therapy. The sequence of surgical treatment and radiation therapy is still debatable. Systemic therapy is also an integral part of long-term control of spinal metastases and depends on the histological structure of the tumor and its ability to respond to drug exposure. Today there is no consensus and an unambiguous standardized, scientifically substantiated approach to solve the existing problem. However, further study of it will be able to provide the choice of the optimal algorithm for curation of patients with metastatic spinal lesions.

Objective. The aim of the study is to improve the results of surgical treatment of metastases of osteogenic sarcomas in the lungs, analysis of factors that may affect the effectiveness of surgical treatment. Methods. The study included 120 patients with lung metastases of bone sarcomas who were treated from 1997 to 2013. Among the patients, there were 64 (53.3%) men and 56 (46.7%) women. The median age for diagnosis was 25 years (13 to 68 years). Most osteogenic tumors were osteosarcomas (56.7%). The indication for surgery in most cases (55%) was metastases in the lungs as the only manifestation of the disease. Most often, operations were performed with unilateral lung damage (57%). Results. Surgeries were predominantly performed with thoracotomy access. The most commonly performed surgeries were atypical lung resections. 23 (19%) patients required a lobectomy. In 113 (94%) patients, operations were performed in the volume of R0. Postoperative complications were noted in 10 (8.5%) patients. The most common postoperative complication was pneumonia, in 1 patient it led to postoperative mortality, in another patient - it led to pulmonary failure. The median followup in the study group was 53.2 months (from 3.5 months to 252 months). When analyzing the frequency of therapeutic pathomorphism in patients with bone sarcoma metastases who underwent chemotherapeutic treatment prior to resection, it was shown that the frequency of achieving complete therapeutic pathomorphism was relatively low - only in 5.5% of patients, in 15% moderate and in 79.5% of patients the effect of chemotherapy was not achieved or only a weak therapeutic pathomorphism was achieved. The overall 5-year survival rate in the study group was 56.4%. Conclusion. Surgical treatment can lead to long-term survival in patients with sarcoma metastases in the lungs, while the best treatment results are achieved with a long relapse-free interval, a small number of metastases and their removal in the amount of R0. Performing operations from thoracoscopic access does not worsen the long-term results of treatment.

The expansion of modern medicine with the latest prosthetics makes relevant the issue of adequate psychological assistance to patients undergoing amputations. The article analyzes the world experience in the study of the quality of life and psychological adaptation to the disease of patients with onco-orthopedic pathology and shows the authors’ experience in the field. An interdisciplinary project developed by specialists from the Saint Petersburg State University (Saint Petersburg) and the N. N. Blokhin National Medical Research Center of Oncology (Moscow) is devoted to the study of the psychological and social factors of patients’ recovery after lower limb amputation, including their return to professional and social activity. The research methodology and technology, which were aimed at assessing objective indicators of the patients’ functional state after amputation in comparison with subjective indicators of quality of life, individual and socio-psychological patients’ characteristics, are justified. The study design reflects a comparative analysis of the main parameters of quality of life and factors influencing it in groups of patients who underwent amputation due to cancer, compared with patients who underwent amputation of the lower limb due to non-oncological diseases (diabetes and atherosclerosis). The study of the patients’ psychological status and quality of life will be carried out in connection with the characteristics of the disease course and treatment. It will provide a personal approach to patients’ rehabilitation and will make the recovery process more effective and less lasting. The developing and introduction of a psychological support program in the preoperative, postoperative and rehabilitation periods for patients undergoing amputation of the lower limb is planned.

The article describes a rare clinical observation of the surgical treatment of a 46-year-old patient with total tumor lesion of the sternum. A surgical extirpation of the sternum was performed, followed by closure of the defect with an individual endoprosthesis made using 3D-printing and a synthetic plate. The report describes the preoperative preparation, the course of the surgery and the early results of treatment.