Soft tissue sarcomas are a group of rare malignant tumors with a high recurrence and mortality rate. Little progress has been made in the treatment of this pathology over the past decades. Surgery with or without adjuvant/neoadjuvant radiotherapy is still the first-line therapy for localized soft tissue sarcomas, and chemotherapy is an additional option for high-risk patients. However, not all patients with advanced or metastatic soft tissue sarcomas benefit from conventional chemotherapy. Soft tissue sarcomas are characterized by high heterogeneity of biological behavior and a variety of genetic mutations, which indicates the perspective of personalized therapy based on tumor histotype, genetic and molecular characteristics, and new small molecule inhibitors of signaling pathways. This article provides an overview of studies on the effectiveness of targeted therapy for the most common soft tissue sarcomas and desmoid tumors.

Current methos of treatment of oncological pathology significantly increase survival rates and patients’ lifespan. However, treatment of malignant tumors leads to development of adverse reactions decreasing its effectiveness and negatively affecting quality of life and survival. It was shown that short- and long-term cardiovascular complications significantly affect the results of therapy.

The article presents data on current scientific research in cardio-oncology touching on the problems of cardiotoxicity, concomitant cardiological disorders in oncological patients, cardiac rehabilitation, and patients’ quality of life. The importance of multidisciplinary approach in the context of reducing the risk of cardiovascular complications is demonstrated.

Introduction. Skin cancer is one of the most common forms of malignant tumors in the Central Asian region and is frequently found in elderly and senile people. Often this pathology is also diagnosed in long-lived patients. Unfortunately, for long-lived patients the choice of adequate treatment methods presents particular difficulties due to the presence of concomitant diseases, a complex psycho-emotional state and expected complications. The inability to carry out specific antitumor treatment according to traditional programs leads to the progression of the tumor process and a significant decrease in the quality of life of patients.

Aim. To determine the importance of radiation therapy in the treatment of skin cancer in long-lived patients (over 90 years old).

Materials and methods. The study included 32 patients – 21 (65.62 %) men and 11 (34.38 %) women, all patients at the initial admission to a specialized medical institution were over the age of 90 years. Some patients were monitored and treated for several years in non-core institutions, they underwent various therapies for continued growth, relapses and metastases. Tumors affected various anatomical areas. Taking into account morphological and general clinical data, 5 (15.62 %) patients were diagnosed with skin cancer of stage T1N0M0, 6 (18.79 %) – T2N0M0, 14 (43.79 %) – T3N0–1M0–1, 7 (21.87 %) – T4N0–1M0–1, which indicates late treatment of patients to oncologists, despite the visual localization of skin cancer. Only 5 (15.62 %) of 32 patients underwent exclusively surgical intervention, telegammatherapy (TGT) as an independent type of treatment – 5 patients with disease in T1–2N0M0 stage. Patients with stage T3–4N0–1M0–1 disease received TGT in a single mode, probably due to the presence of contraindications or the inability to use other methods of treatment. Polychemotherapy in an independent variant was performed to 1 patient, combination therapy (TGT + surgery) – 9 (28.12 %), chemoradiotherapy – 3 (9.37 %), complex therapy (TGT + surgery + polychemotherapy).

Results. Numerous scientific studies devoted to skin cancer, convincingly prove that this pathology mainly occurs in patients in the elderly and senile age (60–75 years). Our experience of treatment in 1049 patients with skin cancer confirms this fact. Standard approaches have been developed for the treatment of various forms of skin cancer, and clinicians achieve good results in the early stages of the disease. It is considered that the patient’s age is relative, and in some cases absolute, a contraindication for antitumor therapy. The assessment of the risk of skin cancer showed that it often occurs in long-lived patients (people over 90 years old) and accounts for 3.05 % of the total number of cases. During the treatment protocols of patients of this group, we were convinced of the reliably frequent localization of skin cancer in longlived patients in the head and neck (40.63 % of cases) and lower extremities (28.12 % of cases). It should be noted that in 4 out of 9 patients, the tumor developed against the background of various injuries and diseases. The majority of patients (21 (65.62 %) out of 32 patients), despite the visual localization of the tumor, turned to oncologists late when they had a locally advanced process or metastases (T3–4N0–1M0–1). The treatment in the form of combined and complex therapy was ineffective. At the same time, in the near term after treatment, signs of a residual tumor were detected in 6 (28.51 %) of 21 patients, relapses – in 4 (19.04 %), and metastasis to distant lymph nodes – in 3 (14.28 %). Probably, the aggressive course of skin cancer in long-lived patients is explained not only by the biological features of the disease, but also by the physiological characteristics of the body. Contrary to existing opinions, the majority of long-lived patients can undergo combined and complex therapy, including repeated courses of radiation therapy with their adequate use.

Conclusion. Despite the advanced age, the presence of concomitant diseases, limited physical abilities, long-lived patients need adequate methods of specialized treatment. Age over 90 years is not an absolute contraindication for antitumor therapy, on the contrary, its adequate choice significantly improves the quality of life of patients. When relapses and metastases of skin cancer appear in long-lived patients, combined and complex antitumor therapy can be performed after a thorough assessment of their condition.

Introduction. Primary malignant tumors of the skeletal system mostly develop in young and middle-aged people. Morbidity in this age group amounts to between 75 and 80 % of overall morbidity. Due to low survival caused by patient death in the first 5 years mostly because of metastases of primary malignant tumors, the main focus of treatment was on prolongation of life, study and development of new methods of conservative therapy. Therefore, until the early 1970 amputation surgery was the generally accepted standard of surgical intervention. Positive oncological results required revision of the surgical concept of treatment in this patient group. This problem was solved through active development of oncological endoprosthesis started in the second half of the 1970s and led to shaping of orthopedic oncology into a separate oncological specialty. The study objective is to study long-term oncological results of treatment of patients with primary and metastatic tumors of the locomotor system after oncological endoprosthesis.

Materials and methods. The study included 1292 patients with primary sarcomas of the bones, soft tissues and patients with metastatic and benign bone tumors who underwent 1200 bone resections/extirpations of varying scale with endoprosthetic replacement between January of 1992 and January of 2020. In the total group of patients who underwent endoprosthesis, the number of men and women was approximately the same: 677 (52.4 %) and 615 (47.6 %), respectively. At the time of surgery, age of the patients in the total group varied between 10 and 81 years. Mean patient age was 34.7 years. Most commonly, endoprosthetic replacement was performed in patients between the ages of 21 and 30 years (in 29 % of cases). Oncological endoprosthesic replacement was performed in 814 (67.8 %) patients with primary malignant tumors, 143 (11.9 %) patients with metastatic lesions in long bones, and 243 (20.3 %) patients with benign neoplasms. Mean follow-up period after endoprosthesis of different bone segments was 82.8 months (between 0 and 335.7 months).

Results. In 27 years of observations, total frequency of recurrences after endoprosthesis for various tumor locations (type V complication per the International Society of Limb Salvage system (2013) (ISOLS 2013)) was 8.8 % (86/979); among them recurrence in the bone (type VA complication) was observed in 1.7 % (17/979) of cases, recurrence in the soft tissues (type VB complication) in 7.0 % (69/979) of cases. Primary endoprosthetic replacement due to recurrence after previous surgical treatment leads to 2.2-time increase in the risk of development of this complication. The obtained results show that repeat recurrence significantly increases the risk of recurrence in soft tissues and does not affect the risk of recurrence in the bone. The most recurrences developed in patients with non-differentiated pleomorphic sarcoma (15.4 % of cases), chondrosarcoma (15.0 % of cases) and parosteal osteosarcoma (14.3 % of cases). Frequency of recurrences in patients with giant cell bone tumors and aneurysmal bone cysts was 4.0 and 3.8 %, respectively. In cases of tumor recurrence after endoprosthesis, limb amputation was the most common treatment: 33.7 % (28/83) of cases. In this study, recurrence mostly developed after femur resection with knee joint endoprosthesis: in 45.8 % (38/83) of cases. Frequency of oncological complications in patients with bone sarcomas who underwent endoprosthetic replacement was 31.9 % (283/886). In the total patient group in 27 years of observations, in 25.3 % (224/886) of patients disease progression in the form of metastases was observed. Local tumor recurrence was accompanied by metastases in 6.7 % (59/886) of cases.

Conclusion. Decreased risk of development of local recurrences depends on the effectiveness of complex approach to therapy in this disease group. Changes in surgical endoprosthesis techniques in tumors of varying differentiation levels allowed to achieve significant radicalness of treatment. Progression risk for bone sarcomas, level of response to specialized therapy and, as a result, patient’s prognosis depend on the presence of epigenetic, genetic, molecular and chromosomal abnormalities.

Introduction. Soft tissue sarcomas (STS) are rare diseases but their characteristic tendency for recurrence and high mortality dictate the need for the search for prognostic biomarkers for identification of patients with the risk of recurrence. In this context, the system of insulin-like growth factors (IGF) and their insulin-like growth factor-binding proteins (IGFBP) is of interest because it was shown that disruption of the IGF system regulation leads to cancer cell proliferation and migration and chemotherapy resistance.

The study objective is to investigate the levels of the IGF system components in blood of patients with primary and recurrent STS.

Materials and methods. In total, 54 patients with STS, T2bN0M0, were examined: 12 men and 12 women with primary STS, 10 men and 20 women with recurrent STS, as well as healthy donors (10 men and 10 women). Mean patient age was 63.1 ± 0.9 years. In blood sampled prior to treatment, the levels of insulin-like growth factor 1 (IGF1), insulin-like growth factor 2 (IGF2) and insulin-like growth factor-binding protein 2 (IGFBP2) were measured by ELISA using Mediagnost kits (Germany). Statistical analysis was performed using Statistica 10 software and non-parametric Mann-Whitney test.

Results. In primary STS, the levels of IGF1 in men with G3–4 tumors and all women decreased 14- and 20-fold, respectively, compared to healthy donors. Additionally, an insignificant decrease of IGF2 level in men and a decrease of IGF1/IGF2 ratio by the factor of 8.8 in men with G3–4 tumors and by the factor of 24.3 in women were observed. In recurrences, IGF1 level decreased by 40 % in men and by 78–85.5 % in women, while IGF2 level in men with G3–4 tumors decreased by 19 %, in women increased by 21–58 % compared to donors. In women with primary STS and recurrences of G3–4 tumors, IGFBP2 was also elevated. In men with G3–4 tumors, changes in IGFBP2 levels were less significant and had an opposite trend compared to women.

Conclusion. STS recurrence is accompanied by imbalance of IGF system components in blood, especially in patients of both sexes with G3–4 tumors. Correlation between increased IGFBP2 level in STS and clinical characteristics of the disease, especially in recurrence, suggest prognostic significance of this molecule.

Introduction. Rhabdomyosarcoma (RMS) is a highly malignant tumor occurring mostly in children. Multimodal therapy is currently promising, however, in patients with high risk (per the stratification scale) low survival rates are observed. There remains a necessity for new possibilities in treatment of this category of patients. Currently, anaplastic lymphoma kinase (ALK) is of considerable interest.

Aim. To study expression of ALK as a potential target marker in RMS tissues.

Materials and methods. In total, 202 histological RMS blocks were studied. ALK expression was qualitatively measured using immunohistochemistry, and its correlation with histological tumors subtype and patient’s clinical data was evaluated.

Results. ALK expression in samples of alveolar RMS was observed in 68 % (41/60) of cases, samples of embryonal RMS in 30 % (26/87) cases, samples of spindle cell/sclerosing RMS in 7 % (1/14) of cases, samples of epithelioid RMS (EpiRMS) in 100 % (2/2) of cases. The study showed correlation between ALK expression and alveolar RMS subtype (р <0.05). In all cases of alveolar RMS with focal ALK D5F3 expression, primarily low or moderate activity levels against anti-myogenin and MyoD1 were observed. ALK-positive samples in the embryonal and spindle cell/sclerosing RMS samples were rarer.

Conclusion. The results show that ALK is a promising target for treatment of patients with RMS. Further study of additional genetic aberrations of ALK is planned which could serve as a springboard for development of targeted therapy.

Soft tissue sarcoma are here, heterogeneous malignant neoplasms that present difficulties in diagnosis, treatment and follow-up. High-quality diagnostic planning allows timely decision-making on further tactics of patient management in a particular case. Positron emission tomography with a biological analogue of glucose – 18F-fluorodeoxyglucose, combined with computed tomography, is an imaging tool that measures the metabolic activity of a tumor and is increasingly used in clinical practice to assess primary tumor tissue, staging, monitoring the effectiveness of treatment and as a method of early detection of relapses. This literature review is aimed at evaluating the usefulness of positron emission tomography combined with computed tomography at different stages of diagnostic control in patients with soft tissue sarcomas.