Treatment of the pain syndrome in cancer patients is one of the most important problems in oncology. And the fact that 85-96% of patients complain to pain makes this aspect of the treatment very actual. Percutaneous biopsy of the spine is small invasive and effective way in the preoperative investigation in patients with spinal tumors and its effectiveness in some cases reaches 83-97%. Percutaneous vertebroplasty is modern and effective way of treatment of patients with spinal tumors. In case of adequate indications to the procedure its effectiveness reaches 85-95%. Complication rate is rather small 2-7%.

Hyperparathyroidism is well known, the osseous lesions it produces are rarely subject to biopsy. The diagnosis is best established by determination of serum levels of calcium and phosphorous or parathyroid hormone. Parathyroid osteopathy produces a lesion, that can mimic metastatic process. The proliferating fibroblastic connective tissue with resorbed trabeculae and sprinkled ostoclast-like giant cells is called «brown tumor» and does not present pathognomonic histologic features.

Aim of the study. To evaluate efficacy and safety of spinal block anesthesia in total knee joint replacement surgery. Materials and methods. Prospective observational study of 67 patients underwent total knee joint replacement with spinal block anesthesia. Patient’s data, perioperative blood loss, necessity of blood transfusions, pain level and additional opioid usage were evaluated. Results. 78% of patients were younger then 45 y.o., chronic pain syndrome was observed in 31%, preop chemo was used in 27%, anemia was seen in 28%. Blood loss during the femoral bone resection was around 400 ml, during tibia and fibula bones 600 ml with total blood loss after surgery of 870 ml and 845 ml respectively. In 100%of patients there were no pain syndrome before and after the surgery. In steady state condition pain level 3 was observed in 78% and the level of dynamic pain did not exceed 4 in 74% of patients. Prolonged block anesthesia failed to systemic anesthesia in 15% of patients. Conclusion. In 85% of cases spinal block anesthesia provided an excellent control with minimal usage of narcotic agents.

Fibroblastic sarcomas are a heterogeneous group of tumors that account for about 1% of adult cancers. The group includes 11 low-grade and high-grade tumors located on the extremities and trunk. All tumors composed of neoplastic fibroblasts and myofibroblasts. Fibroblastic sarcomas are rare and not well studied. Little is known about it histology, genetic, natural history or optimal treatment. This article summarizes what is known to date about fibroblastic sarcomas, including classification, epidemiology, approach to diagnosis and outcomes of these tumors.

Background. Diagnostics and quality treatment improvement of patients with metastases of unknown primary site. Methods. A retrospective chart review of patient history cases and outpatient’s cards was carried out relating to 581 patients with Metastases of Unknown Primary Site Malignances (MUPSM) who were examined and treated in the Clinical Oncological Dispensary, 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 melanoma of unknown primary site accounts for 6,2% of total number of patients with CUP (Cancer of Unknown Primary). It was confirmed that the immunohistochemical examination has proven to be the principle method of morphological diagnosis in the above group of patients with melanoma of unknown primary site. The survival rate of the patients with Melanoma of Unknown Primary 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 are 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 melanoma of unknown primary site 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.

Melanoma refers to malignant tumors with a primary metastasis to the brain. Complications associated with brain damage are the leading cause of death in patients with this pathology. The study analyzed the results of treatment of 57 patients with metastatic brain lesions. Treatment was conducted on Leksell Gamma Knife 4C (Elekta, Sweden) in the period from 2009 to 2012. The average lifespan of the treated patients was 7,2 months from the first radiosurgical operation, local control was achieved in 92% metastatic brain lesions, disease-free three-month survival rate was 73%, six-month 24% and twelve-month 7%. Our data confirm that radiosurgery is an effective method for the treatment of patients with metastasis of radioresistant tumors, including melanoma, to the brain. The treatment increases survival rate and allows to achieve high local control with minimal mortality.

We have carried out the analysis of structure of recurrent malignant neoplasm by the constantly observed group of population after the radically cured MS. Materials and methods. From the year 1978 till 2011 100.000 people were under the constant clinical observation. The MS was diagnosed by 507 patients (243 men and 264 women). By all patients the diagnose was verified cytologically and/or histologically. The radical surgical cure of MS was done to 304 (60%) patients on the I stage; 106 (21%) on the II and 40 (8%) -on the III stage. By 56 (11%) people the stage was not established. In addition to the surgical cure 132 (26%) patients got chemotherapy and 7 (1,4%) immunotherapy. Later on all these patients were under the constant clinical observation. Results. Among 507 patients, who were treated for the MS, by 70 (14%) were other tumors subsequently exposed. This group includes 38(53%) men and 32(47%) women. By 70 patients were exposed 94 tumors, that chronologically appeared synchronically 81(86%) or metachronically 13 (14%). By 60 (86%) patients one tumor was diagnosed, by 6 (8%) two, by 3(4%) three, by one (1%) eleven tumors. The most often in a capacity of the second neoplasm was found basal cell carcinoma (BCC) 31 (33%) tumors. Most frequently BCC was diagnosed by men at the age of 50-59 years 14 (15%) tumors. Among the somatic oncopathology by the patients with MS in anamnesis the most often was found malignant neoplasm of the digestive tract 13 (14%) tumors, 5 (5%) of them falling to the share of stomach cancer. More seldom was diagnosed the neoplasm of prostate gland 12 (13%) neoplasias, breast cancer 8 (8,5%). Most often somatic neoplasm was exposed by men at the age of 70-79 years. By 37 (52%) patients the tumors were diagnosed after 6 or more years after the cured MS. Conclusions. After the radical treating of MS the long, maybe lifelong observations of such patients with oncologist and dermatologist are needed. A particular attention, obviously, should be given to the dermatologists’s examination of men at the age of 50-59 years and the inspection of digestive tract and prostate of men at the age of 70-79 years and the inspection of breast cancer of women at the age 70-79 years.

The aim of the study was to obtain experimental data on the specific antitumor activity of the thermochemotherapy (TCT), which combines local ultrasound hyperthermia and chemotherapy with iphosphamide and uroprotector natrium bicarbonate. Material and methods. The experiments were performed on mice with murine intramuscular transplanted hematogenic metastatic tumors Lewis lung carcinoma LLC and melanoma B16 with average volume of 0,8-1,7 cm³. Local ultrasound hyperthermia (US-HT) was performed on the original ultrasonic device USDT-m with local ultrasound of two frequencies (0,88 and 2,64 MHz) simultaneously with a maximum intensity of 2,5-3,0 W/cm² in the temperature 41,5⁰C. Ultrasonic treatment was carried out after systemic chemotherapy with ifosphamide (Ifo) and uroprotector natrium bacarbonate (NB). Results. It was shown that 1-2 courses of thermochemotherapy of the scheme NB+ 15 min + Ifo + 3 h + US-HT allows reducing the size of the tumor in 7-11 times with the same or less toxicity as demonstrates Ifo alone. Conclusion. The obtained results suggest a possibility to include the scheme of NB+Ifo+US-HT on USDT-m in clinical trial for preoperative treatment of patients with soft tissue sarcoma.

Primary malignant bone tumors are rare with an estimated frequency is about 1,5-2% of all malignant tumors. The diagnosis and management of these neoplasms require multidisciplinary team approach, which includes orthopaedic surgeons, radiologists, pathologists and oncologists. With this approach and modern treatment 5-year survival of osteosarcoma and Ewing’s sarcoma is 70 and 60% respectively. The major advancements over the past few years in orthopaedic pathology are molecular studies, including genetic and immunoperoxidase studies. Newer surgical techniques, minimally invasive surgical procedures, tumor chemotherapy, bisphosphonates are new advancements.

It has been reported a case of intraoperative electrical nerve injury.