Delivering of chemotherapy for locally advanced or advanced soft tissue sarcomas and osteosarcomas patients has become infeasible without providing for pertinent vascular access. A majority of recent chemotherapeutic agents are either vesicants or irritants agents and therefore require special options for their intravascular administration, which provides for the most effective and safest systemic or regional effect. A number of various issues, associated with intravascular drug administration as a part of present sarcoma treatment regimes and providing of long-term vascular access for better quality of life of cancer patients is discussed in this article. Experience and techniques of insertion and maintenance of various types of vascular access systems, performed in N.N. Blokhin Russian Cancer Research Centre, are described in the article. Subcutaneous implantation of port - a totally implantable central venous access device designed for multiple intermittent infusions - is indicated in order to facilitate drug administration, avoiding extravasation, phlebitis and other complications, associated with systemic and regional chemotherapy.

Materials and methods. 207 patients has been executed 309 percutaneous vertebroplasty, 41 osteoplasty and 52 radiofrequency thermal ablation, middle age has 48 years. Most often minimally invasive methods were carried out to patients with bones metastasis lesions of breast cancer - 95 (45,5%) and kidneys cancer - 22 (10%) patients. Results. Reduction of pain syndrome on a visual analog scale after operation was noted in 182 (88%) patients. On scale Watkins positive dynamics was regestered in 170 (82%). Improvement of quality of a life on scale Karnofski in 141 (68%) patients. Complications after vertebroplasty and osteoplasty in the form of methylmethacrylate leak into the surrounding tissues out of the channel were observed at 23 (12%) patients. One patient after radiofrequency thermal ablation has developed burn skin. Three pathological fractures of the bone segment were observed after radiofrequency thermal ablation. Conclusions. Vertebroplasty, osteoplasty and radiofrequency thermal ablation - minimally invasive methods of treatment of patients with tumor defeat of the bones, allowing a short term relieve of pain syndrome, to create adequate stability in bone segment and to improve quality of a life of oncological patients.

Background. To evaluate the efficacy and toxicity of dose-dense high dose ifosfamide and adriamycin in the treatment of locally advanced and metastatic soft tissue sarcomas. Materials and methods. 26 patients where included in the interim analysis by the end of 2009. Dose dense high dose (DDHD) AI ifosfamide 2000 mg/m² IV 1-5 days with adriamycin 60 mg/m² IV day 1 with GM-CSF support 6-14 once in 2 weeks was used in 23 STS patients. Male 60%, female 40% with the median age of 42 years old (22-63 years old). From 26 patients at the beginning of DDHD AI chemotherapy 10 patients were locally advanced, and 16 - with distant metastases. Tumor assessment was made according to RECIST criteria after every 2 cycles. Histology - synovial 11 pts, MFH - 3 pts, lipo - 6 pts, leiomyo - 1 and 2 NOS sarcomas. Results. Objective response has achieved in 43,5% (CR - 13,1%, PR - 30,4%), stable disease - 39,1%, disease progression in 17,4%. Toxicity profile was manageable and mild: leucopenia 56% with Gr 3-4 23%, neutropenia - 47% (Gr 3-4 - 9%), anemia - 52% with no Gr 3-4, thrombocytopenia 17% (Gr 3-4 - 9%). Conclusion. This chemotherapy regimen seems to be very active in the treatment of STS patients with mild and manageable toxicity profile and needs further evaluation of the impact on overall survival and time to progression. This trial is still ongoing.

The cinicopathological classification of sarcomas in general, and specifically of soft tissue sarcomas, is becoming more complex, due not only to the increasing number of new entities identified in recent years, but also to the fact that most of these neoplasms have a common mesenchymal cell origin. Thus, these tumors might express a divergent phenotype with numerous histological varieties with overlapping features, producing confusion in their identification. Therefore, any histological study needs to be complemented with both immunohistochemistry and electron microscopy as well as with new ancillary techniques such as cytogenetics and especially molecular biology. Thus, nowadays it is mandatory to combine the clinical stage, histological grade histological variety and immunohistochemical characterization in order to obtain a clear pattern for a given sarcoma and its prognostic outcome. Additionally, cytogenetics and molecular biology identify two clearly different subgroups of sarcomas: those presenting mainly a small number of rearrangements with specific chromosomal and genetic translocations against a second, larger group of neoplasms harboring complex kariotype reorganizations and numerous genetic imbalances. Although few of these genetic reorganizations provide any additional value for establishing predictive or prognostic outcome for the patient, they have opened up new ways to obtain more precise classification, complementing conventional histology and simultaneously creating new possibilities for targeted therapy. This review on soft tissue sarcomas provides the most up-to-date findings in these fields, reviewing the clinical stage, histopathology, immunohistochemistry and molecular biology of the major soft-tissue tumor types based upon the WHO classification.

Non-epitheliod tumors is a very rear disease in children and adolesents. In this paper 4 cases of rhabdomyosarcoma and foliod tumor are discusssed (4 female children at the age of 14). Clinical symptoms, diagnostic methods and treatment options are highlighted.

Backgrounds. To evaluate the problem of non-invasive diagnostics of melanoma and to increase early diagnostics by using new non-invasive methods (dermatoscopy, siascopy). Materials and methods. Since May to September 2009 in N.N. Blokhin Cancer Research Centre RAMS 56 patients were treated. In all cases surgical treatment was made. This study is based on pathomorphologic investigations of 163 pigmented skin lesions. The main indications for surgery were ABCD rule, 7 point check list by Argenziano and spectrophotometric intracutaneous analysis. Results. Dermatoscopy and siascopy are the main early noninvasive diagnostic methods of melanoma and skin cancer. Conclusion: Comparative simplicity, non-invasive technique and high effectiveness of dermatoscopy and siascopy allow wide using of these methods for early diagnostic of melanoma.

Background. Metastatic melanoma in most cases remains incurable disease. Current treatment options are limited and mainly consist of systemic treatment such as dacarbazine with or without other chemotherapeutic agents. We have investigated new chemotherapy regimen, which combines two potent drugs fotemustine and carboplatin and compared it to fotemustine alone. Patients and methods. Between March and August 2008 37 patients with metastatic melanoma were included. 18 pts received fotemustine + carboplatin (group 1) and 19 pts received fotemustine alone (group 2). Both groups did not differ significantly in baseline characteristics (age, sex, stage and number of involved sites). Three pts in group 1 and 10 in group 2 had been never treated for metastatic melanoma. Fourteen and 13 pts had cutaneous melanoma in group 1 and 2 respectively; other patients had uveal melanoma, mucosal melanoma and metastases from UPO. The schedule of fotemustine infusions was the same in both arms: induction consists of fotemustine 100 mg/m² on day 1, 8 and 15 followed by the 5 week treatment-free interval. If no progression was detected, supportive cycles of fotemustine 100 mg/m² on day 1 were performed every 28 days. In combination group carboplatin (AUC=5) administered each cycle on day 2. Results. According to RECIST we registered 2 complete responses and 1 partial response, 6 pts were stable in group 1; in group 2 only 1 partial response was detected, 8 pts remained stable (р>0,5). Median PFS was 3,7 (95% CI 1 to 6.4) months and 3,1 (95% CI 0,8 to 5,4) months in group 1 and 2 respectively (р>0,53). Median OS in group 2 was 11,9 months, and median OS in group 1 is still not reached. Both treatments were comparable in respect to toxicity they induced. Most common side effects were trombocytopenia (grade 3-4 7/18 and 6/19 pts for group 1 and 2 respectively) and neutropenia (grade 3-4 7/18 and 5/19 pts for group 1 and 2 respectively). In one patient from group 1 non-fatal brain hemorrhage occurred. Conclusion. No significant benefit from combined treatment with fotemustine and carboplatin were revealed, so we do not recommend this regimen for routine use in advanced melanoma. Higher frequency of objective responses in combined treatment group should be proven in well-organized controlled trials.

Background. Diagnostics and quality treatment improvement of patients with Metastases of Unknown Primary Site Melanoma. Methods. A retrospective chart review of patient’s medical histories and outpatient’s charts were carried out relating to 581 patients with Metastases of Unknown Primary Site Malignances (MUPSM) who were examined and treated in the Clinical Oncological Dispensary, Ministry of Health Care, Tatarstan Republic, Kazan City, Russia, over the period from 1996 until 2008. Based on histological examination of metastases, 36 patients were diagnosed with melanoma. Results. The number of patients with Metastases of Unknown Primary Site Melanoma was 6,2% of total number of patients with MUPSM (Metastases of Unknown Primary Site Malignances). It was confirmed by immunohistochemical examination as a principle method of morphological diagnosis in the above group of patients with Metastases of Unknown Primary Site Melanoma. The survival rate of the patients with Metastases of Unknown Primary Site Melanoma were correlated with the survival rate of the patients with similarly advanced metastases but with diagnosed Primary Origin. The five-year survival rates for the stage IIIC were 18,2% and 18,4% (p=0,042); for the stage IV are 7,1% and 6,0% (p=0,078) respectively. Conclusion. It is worthwhile to define the stage of the diagnosed Metastases of Unknown Primary Site Melanoma in accordance with TNM-'2002 classification. The survival rate of the above group of patients is comparable to the results, obtained in the patients group with diagnosed primary origin. The missing primary site in metastatic melanoma is not a factor which significantly affects the survival rates of the above groups of patients.