This article presents a review of international and national literature on the use of computer modeling and 3D-technologies in oncological orthopedics. The use of preoperative planning, patient specific instruments and individual prostheses for malignant tumors of pelvis, scapula, sternum, calcaneus, etc. are analyzed in this article.

Objective. To estimate the effectiveness and tolerance of soft tissue sarcoma (STS) combined treatment, including preoperative thermoradiotherapy (TRT), surgical treatment and intraoperative radiation therapy (IORT).

Methods. We assessed the tolerance and both immediate and long-term results of treatment for 105 patients with locally advanced STS, 50 of whom underwent combined treatment with local hyperthermia (LHT) (prospective set). 55 patients from the control group received treatment without the use of LHT (retrospective group).

Results. It was proven that the preoperative course of TRT significantly increases the frequency of objective clinical response in the study group — 30% versus 9.1% in the control (p<0.05). The prevalence of two-year relapse-free and overall survival was observed in patients of the study group with recurrent STS — 77.8% compared with the control group — 46.7% (p=0.05) and 100% versus 86.7%, respectively (p=0.05). The incidence of early radiation reactions and late radiation changes is comparable in both groups.

Conclusion. The use of TPT contributes to a significant increase in the frequency of an objective clinical response, and allows to improve two-year relapse-free and overall survival in a subgroup of patients with relapses of SMT. When prescribing the TRT course, it is necessary to take into account the main clinical and morphological factors that have a significant impact on its immediate effectiveness. LHT as a radiosensitizer in the combined treatment of SMT does not adversely affect the frequency and degree of radiation reactions/changes in normal tissues.

Introduction. The formation of thoracoabdominal hernia (TAH) after the chest wall resection is described in a single publication of foreign literature. The reasons for the formation of TAH, the development and surgical methods of prevention remain unstudied.

Materials and methods. In N.N. Blokhin Center of Oncology from 2000 till 2019, there had been 258 surgical interventions performed on primary and metastatic tumors. These were resections of one or several ribs, or sternum with simultaneous reconstruction with local or displaced tissues, in some cases, using various allogenic materials. TAH was detected in 48 cases. The results. The key risk factors for hernia formation were: resection of the VII rib and below, lack of reconstruction of the costal arch, defect of the chest wall with the surface of 50 cm² or more.

Reconstruction with local tissues or a displaced flap is able to prevent the formation of TAH only in the cases of defect of the chest wall with the surface within 60 cm², with the use of a GorTex Dual mash® plate, with a defect of up to 70 cm², and with the use of rigid reconstruction methods, up to 145 cm².

Conclusions. The most obvious reason for the formation of TAH, is the intra-abdominal pressure on the area of the chest wall defect.

The surgeon should consider these risk factors and bear in mind the need for additional reconstruction of the chest wall to prevent the formation of TAH.

The article is devoted to methodology of studying health-related quality of life in oncoortopaedy and oncovertebrology. Quality of life research in oncoorthopedic clinic requires a complex of methods, including both general questionnaires studying quality of life in patients with chronic diseases, and specific methods studying quality of life in oncological patients, including questionnaires aimed at identifying main parameters of quality of life in patients with bone tumors. For focused studying quality of life at the pre- and postoperative stages of treatment in patients with bone tumors, specific questionnaire is needed, consequently the authors validated Russian-language version of the questionnaire EORTC BM22 («Bone metastases» — 22). The results of BM22 validation showed its high information content in assessing the main parameters of quality of life in patients with bone tumors. The new BM22 quality of life questionnaire can be recommended for use in oncoorthopaedic clinic for more accurate and differentiated assessment of quality of life in oncoorthopaedic patients.

In the surgical treatment of benign as well as low aggressive malignant (G1) bone tumors of small sizes, methods such as intralesional curettage, marginal resection, resection of part of the joint, or resection of the affected bone segment are used. In cases when intraosseous removal of the tumor is performed, there is a need for bone grafting of the defect, the purpose of which is to maintain and strengthen the structural strength of the bone, replace the volume of the bone defect, and accelerate the biological stimulation of bone tissue regeneration during fractures. The most widespread use of synthetic bone graft substitute based on calcium sulfate and calcium phosphate.

The study included 24 patients, 15 (62.5%) of whom were diagnosed with chondrosarcoma G1, 9 (37.5%) were diagnosed with enchondroma. For these patients, from 2015 to 2019 (52 months), surgical treatment was performed in the amount of curettage with replacement of the defect with the phosphate calcium bone graft substitute. In the studied group of patients, in 12 (50%) the tumor was localized in the femur, in 10 (41.7%) in the humerus, in the tibia and radius of the 1 patient, respectively. The mean follow-up period was 32 months and ranged from 7 to 52 months.

In the present study, during the observation period, none of the patients was diagnosed with local recurrence, distant metastasis, bone fracture, loss of bone graft substitute and infection. All patients showed satisfactory integration of tricalcium phosphate bone graft substitute. The average functional result after 6 months for the upper limb was 94%, for the lower limb 96%, according to the MSTS scale.

Replacing of the formed bone defects with a synthetic bone graft substitute containing tricalcium phosphate provides reliable, predictably fast kinetics of resorption and substitution.

Introduction. The study of the causes of decreased function of the upper limb (DFUL) after the chest wall resection has been the focus of only a few publications. Resection of the sternoclavicular joint and clavicle is an obvious reason for the DFUL. Other reasons are not so obvious - displacement of the pectoralis major muscle or its resection, intersection or resection of the trapezius or rhomboid muscles, large defect of the chest wall in the area covered with the scapula. The approach to reconstruction of the chest wall, i.e. the ability to prevent or reduce the degree of declined function.

Material and methods. In the N.N. Blokhin NMIC of Oncology from 2000 to 2019, 258 surgical procedures have been performed on primary and metastatic tumors localized on the chest wall. 123 patients (47.7%) suffered of functional disorders in upper limb postoperatively. The deterioration was due to the movement of the pectoralis major muscle or resection, after trapezius and/or rhomboid muscles were crossed or resected, after large defects of the chest wall in the area covered with the scapula, after interventions on the sternoclavicular joint. We used assessed the MSTS scale for assessment of the severity of DFUL. Mathematical accuracy was calculated using UTest Mann-Whitney, χ².

The results. The intersection or resection of the trapezius or rhomboid muscles did not lead to a significant DFUL. Resection of the pectoralis major muscle and its use as a displaced flap is only in rare cases accompanied by a DFUL of less than 80%. More severe DFUL had been in patients with a larger volume of resection of the pectoralis major muscle or after usage of counter pectoral flaps with excessive tension. Resections in the sternoclavicular joint area naturally led to DFUL up to 20% or more according to MSTS. Defects of the chest wall in the area covered by the scapula and adjacent areas, ranging from 50 cm² to 320 cm² (M_d=105 cm²), followed by DFUL 20% or more.

Conclusions. Interventions on the trapezius, rhomboid and pectoralis major muscles did not lead to a significant DFUL. In cases of interventions on the sternoclavicular joint, movable reconstruction with a low risk of instability should be performed. At the same time, the choice of reconstruction method remains the subject of research, as well as for the reconstruction of a defect in the area covered by the scapula.

The article presents a clinical case of treating a patient with iliac osteosarcoma who underwent pelvic resection with the replacement of the defect with an individual implant. Data of computed tomography (CT), a digital three-dimensional model of the pelvis reconstructed and a physical model made using 3D-printing. The optimal volume of bone resection was determined taking into account oncological principles. An implant design developed taking into account the anatomical features of the patient using computer simulation. A computer model of the pelvic bones with a defect replaced by an individual implant analyzed by the finite element method to determine the stress zones in the skeleton-implant system. The surgery was performed according to a previously plan, after the removal of the tumor, an individual pelvic prosthesis and hip prosthesis were successfully implanted. The patient followed up for 2 years, without the progression of the disease and the development of orthopedic complications with a good functional result. The use of computer design and 3D-printing of the pelvic prosthesis according to an individual project may be the optimal method of choice for the treatment of patients with tumors of the pelvic bones with a good clinical and functional result.

Journal bibliography. 2019.