Systemic treatment of patients with advanced STS may include cytotoxic chemotherapy and/or targeted therapy. Although the use of targeted drugs with a more favorable toxicity profile than cytotoxic drugs is more attractive, the use of cytotoxic therapy generally demonstrates better results. Currently, different morphological types of soft tissue sarcomas require different therapies. Necessity of carrying out of 2^nd and more lines of therapy at SMT does not raise doubts, however now clear algorithms of treatment are not yet developed.
Objective. To evaluate the efficacy of trabectedin, pazopanib and a combination of gemcitabine and docetaxel as a second line of treatment for patients with soft tissue sarcomas
Materials and methods. 106 patients with different STS were divided into three treatment groups: 1st group of patients (n=43) received trabectedin 1,5 mg/m2 as a 24-hour continuous intravenous infusion every 3 weeks; The 2nd group of patients (n=37) received pazopanib 800 mg orally once a day; third group of patients (n=26) received combination of gemcitabine and docetaxel (GemTax): gemcitabine 900 mg/m2 IV in a 1,5 hour infusion on days 1 and 8, docetaxel 100 mg/m2 IV the 8th day every 3 weeks with G-CSF support. Tumor assessment was done according to RECIST 1.1 criteria.
Results. The efficacy of the combination of gemcitabine and docetaxel was evaluated in 26 patients: CR – 1 patient (3,8%), PR – 6 patients (23,1%), SD – 13 patients (50%), PD – 6 patients (23,1%). Thus, tumor control rate (complete remission, partial remission, stabilization) was 76,9%. The median time to progression was 6,7 months. The median overall survival was 15,4 months.
The effectiveness of pazopanib was evaluated in 37 patients: CR – 0%, PR – 4 patients (10,8%), SD – 27 patients (73%), PD – 6 patients (16,2%). Thus, tumor control rate was 83,8%. The median time to progression was 7 months. Median overall survival was 14,5 months.
Efficacy of trabectedin was evaluated in 43 patients: CR – 0%, PR – 4 patients (9,3%), SD – 21 patients (48,8%), PD – 18 patients (41,9%). Thus, tumor control rate was 58,1%. The median time to progression was 2,3 months. Median overall survival was 10,3 months. The toxicity profile did not differ from the world published data.
Conclusions. When comparing chemotherapy regimens, we obtained the following data – for leiomyosarcomas and angiosarcomas, the use of high-dosage chemotherapy GemTax as the second line showed the highest indices of median PFS 10 and 8,2 months, respectively. The median OS was 14,7 and 15,3 months, respectively. For synovial sarcomas, the use of pazopanib showed the longest median PFS equal to 14 months. Median OS was 15,5 months, so pazopanib the most preferable regimen of second line therapy. In case of liposarcomas, the use of trabectedin in the second line shows the best results: the median PFS was 2,1 months, and the median OS was 8,3 months. With insensitive and weakly sensitive subtypes of soft tissue sarcomas to standard chemotherapy regimens, pazopanib shows high rates of median PFS and OS. Therefore, the use of pazopanib is possible both in the second line of therapy, and also in the front line of treatment for chemoresistant subtypes of advanced STS.

Secondary chondrosarcoma is a distinctive type of tumor that arises from cartilage lesion. Frequently it has a connection with single or multiple osteochondromas. Some cases arise from other diseases, such as Maffucci Syndrome and Ollier’s disease. A sharp increase in the size of the «cartilaginous cap» osteochondromas is a sign of transformation into a secondary chondrosarcoma. However, there is no strict restriction on the thickness of the «cartilaginous cap», which can be considered pathognomonic malignancy. The overall survival rate for 5 years is approximately 90%. Surgical resection with wide margins is the best treatment option, but local recurrence remains a significant problem in about 10–20% of patients. Patients with secondary pelvic chondrosarcoma are particularly at risk of local recurrence.

Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the synovial tissue of a joint tendon sheath or bursa. The nodules may enlarge and detach from the synovium. Numerous data is available about the synovial chondromatosis of the knee joint, followed by the hip and ankle. Although much has been written about synovial chondromatosis of the large joints, only few case reports of synovial chondromatosis of the spine reported in the English literature. Synovial chondromatosis should be considered in the differential diagnosis when evaluating additional mass in epidural and/or paraspinal tissue near a facet joint, especially when there is evidence of bone erosion, dark signal or nodules on T1 and/or T2, fluid or myxoid signal centrally with thin or nodular peripheral enhancement. Compression on bone and nerves is caused by calcified loose or attached to synovium bodies.

Objective. Demonstration of the use of electrochemotherapy (ECT) in the treatment of superficial metastases of skin melanoma.
Materials and methods. ECT was performed in 4 patients with stage IV skin melanoma. Bleomycin was administered intravenously bolus 15 mg/m2. The effects of electrical impulses on each tumor site and adjacent tissues were performed through the needle electrode of a pulse generator (Cliniporator, Igea, Modena, Italy).
Results. In all patients, after 15–30 days from the time of ECT, complete regression of the tumor nodes was observed. In 2 patients from the moment of ECT there is no recurrence and growth of new foci within 10 months. In 1 patient 3 months after the ECT there was a relapse of the tumor, in 1 – in 5 months there was a relapse of metastatic formations and the appearance of new foci in the nearby anatomical areas.
The conclusion. ECT can be a method of choice of treatment in patients with superficial melanoma metastases, which allows to increase the effectiveness of systemic and local therapy.

In our article the experience of treating patients with soft tissue sarcomas in the National Center of Oncology and Hematology is given. The purpose of the study was the use of modern methods of diagnosis and treatment of soft tissue sarcomas. For the first time in the Kyrgyz Republic, modern schemes of drug therapy were applied at the stage of combined treatment with the use of high-dose polychemotherapy regimens in the form of continuous 24-hour infusion. As a result of our study of patients with soft tissue sarcomas, mortality at the follow-up period from 8 to 35 months. was 46,2%, which corresponds to the average statistical data.

This article shows the successful experience of surgical treatment of the patient with relapse chondrosarcoma on the thoracic wall. Reconstruction of the combined defect was performed with latissimus dorsi flap and Synthes Matrix Rib titanium plates. This method saved the upper limb and its satisfactory function due to vascular prosthetics and complex rehabilitation. Good oncological and functional result confirms the advisability of surgical treatment of such patients and by multidisciplinary approach in planning, performing the operation and managing the postoperative period.

Mesenchymal chondrosarcoma is a malignant tumor, characterized by the presence of differentiated cartilage and simultaneously highly vascularized spindle cells or mesenchymal tissue from round shape cells. The case report of 27-year-old patient with a mesenchymal chondrosarcoma of the right temporal bone G3 is presented. In this patient the progression of the disease was discovered 6 years after the manifestation with a metastasis in the right lung. Conducted chemotherapy was ineffective and as a result surgical treatment was performed in the volume of right pneumonectomy with circular resection of the tracheal bifurcation.