EDITORIAL
We report results of single institution trial of 78 STS pts treated with front line high dose doxorubicin with ifosfamide in comparison with 50 pts treated retrospectively with standard MAID regimen. We achieved 44% increase in PFS (from 5 to 7.2 month) and OS (from 10 to 19.2 month) in high dose subgroup (p=0.00001). New regimen showed high activity and durable toxicity profile and can be used routinely only in specialized sarcoma centers across the country.
BONE TUMORS
The review of the literature is devoted to the classification, epidemiology, clinical presentation and radiological findings of osteoblastoma. osteoblastoma is a rare benign bone producing tumor, that develops in a young group of patients. Histological structure of osteoblastoma is similar to osteoid-osteoma. However, these two benign tumours are classified into different nosological forms based on their clinical and radiological manifestation. size is the main criterion for differentiation of these two processes, which exceeds 2 cm in cases of osteoblastoma.
The present study analyzed the results of a survey conducted with 179 patients to identify their malignant neoplasms under the National Clinical Oncology Center. All patients underwent ultrasound of the inferior vena cava, iliac veins, the veins of the lower extremities. Among patients with sarcomas of bone and soft tissues of the number of patients with venous thrombosis was significantly higher than in patients without cancer. Manifestations of procoagulant activity of sarcomas can be set by ultrasound diagnosis of idiopathic venous thrombosis of the inferior vena cava in this group of patients.
Primary bones tumors make 0,2–1% of all oncological diseases (1,2–1,9 cases on 100 000 population). In dynamics for the past10 years according to statistical data of Republic Kazakhstan incidence is stable, mortality is decreasing, and 5-year survival increased for 10%.
Since 2012 Center of tumors of bones, soft tissue and melanomas was established. From 2005 till 2014 772 patients with primary tumors of bones and soft tissues and also metastatic bone involvement were treated.
SOFT TISSUE SARCOMAS
Increased incidence of melanoma and soft tissue sarcomas of the extremities is observed nowadays. High probability of developing locally advanced forms of melanoma and soft tissue sarcomas of extremities lead to the use of combined treatment methods is quite high. In the 21st century the possibility of isolated limb perfusion chemotherapy gives patients a high objective response to therapy without their systemic administration, improving quality of life through the limb salvage. This review describes currently used therapeutic agents, results of ongoing clinical trials and personal data.
Surgery on the upper extremity reconstruction with displaced skin – muscle flaps performed in 38 patients with locally advanced common soft tissue sarcomas and skin tumors of the upper extremity, in 27 cases was used the radial flap. Postoperative complications in the form of necrosis of the flap occurred in 2 patients. All patients after operation note good and satisfactory functional and cosmetic results. Radial flap on a vascular pedicle or free with microsurgical vascular anastomosis is the method of choice for the reconstruction of postoperative defects of the upper extremity.
The belief about radioresistance of soft tissue sarcomas remained unchanged within several decades; however, recent data on heterogeneity of these tumors and radiotherapy effectiveness doubted that. Radiation therapy has been traditionally applied in the postoperative setting after R0 and, especially, R1 resection of tumors more than 5 cm in diameter, mostly for local control improvement. such approach appears to be standard and recommended by many oncological centers. however, preoperative irradiation of sarcomas may have firm theoretical advantages supported by experimental and clinical data. currently, the most promising therapeutic options with external beam radiotherapy are: combination with chemotherapy and targeted treatment; modern radiotherapy technique such as IMRT, intraoperative radiotherapy, brachytherapy; hadron therapy (protons, neutrons, heavy ions); combination with local hyperthermia.
TUMORS OF THE SKIN
Merkel-cell carcinoma is a rare and highly aggressive skin cancer. It is characterized by a variety of histological subtypes and features that cause difficulties in morphological diagnosis. Estimation of Merkel-cell carcinoma prognosis is one of the priorities. Histological, immunohistochemical and clinical characteristics of the tumor are prognostic factors in Merkel-cell carcinoma.
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