Introduction. Selection of surgical treatment tactics for patients with bone metastases is one of the important problems of modern oncology. In the majority of patients with metastatic bone lesions, surgical interventions are aimed at palliative treatment; however, in some cases of solitary metastases, radical resections with a reconstructive component can be performed. Lifespan prognosis associated with histological structure of malignant tumor is the main and crucial factor in determination of suitable type of surgical treatment.

Aim. To create software for selection of surgical tactics treatment in patients with bone metastases.

Materials and methods. Treatments of 715 patients who underwent surgical interventions for bone metastases of various locations were analyzed. In total, 780 surgeries were performed. Surgical interventions due to complex progression of bone metastases in the vertebral bones were performed in 48.5 % of cases, long bones in 247 (35 %) cases, pelvic bones in 81 (11 %) cases, thoracic bones in 40 (5.5 %) cases.

Results. Complete elimination or significant reduction of pain syndrome after surgical treatment of bone metastases were observed in 629 (88 %) patients. Improved quality of life per the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales after surgery was observed in 633 (88.5 %) patients. Postoperative complications developed in 49 (7 %) patients, mostly of infectious type (21 (3 %) cases). Errors in selection of surgical treatment tactics were identified in 49 (7 %) cases. Overall 1-year survival was 52 %. Based on the results of analysis of international literature data and our own experience, treatment algorithm for this patient category was modernized, and 14-point lifespan prognosis scale was developed. Their use allowed to develop the BoneMetaLife software for determination of surgical treatment tactics for bone metastases.

Conclusion. Adequate surgical tactics for treatment of bone metastases of various parts of the skeleton and favorable oncological prognosis improves patients’ quality of life and increases survival in patients with solitary metastases. Development of new treatment tactics based on patient lifespan prognosis and algorithms of surgical treatment will allow to decrease the probability of errors in selection of onco-orthopedic help and increase treatment effectiveness.

Currently, stratification of recurrence risk and prognosis of 5-year survival of patients with soft tissue sarcomas are primarily based on histological tumor classification. Drawing from these data, international oncological societies have proposed a hypothesis about development of gene expression profiling and molecular and genetic diagnosis technologies which will allow to more accurately assess risks of soft tissue sarcoma development and select individual drug treatment.

Introduction. Oncologic endoprosthesis of the knee joint in patients with tumors of the proximal calf requires reconstruction of the joint and surrounding structures including the extensor mechanism. This study is based on our experience of using titanium meshes as additional fixation aids for attachment of the patellar ligament to the endoprosthesis. We have developed a technique of extensor mechanism reconstruction and performed comprehensive assessment of the results of its clinical use.

Aim. To evaluate the effectiveness of using titanium meshes for reconstruction of the knee extensor mechanism during primary and revision oncologic endoprosthesis of the knee joint.

Materials and methods. The study included 2 stages: 1) retrospective analysis of the effectiveness of using titanium mesh implants in primary endoprosthesis of the knee joint; 2) prospective study to evaluate the results of using polymer and titanium meshes during revision oncologic endoprosthesis of the knee joint.

The retrospective study included 78 patients divided into 3 groups: the 1st group included 25 patients in whom the extensor mechanism was attached directly to the endoprosthesis; the 2nd group included 30 patients who underwent surgery involving use of a polymer mesh; the 3rd group included 23 patients who underwent surgery involving use of a titanium mesh.

In the prospective study, analysis of the results of treatment of 40 patients who underwent surgery between 2019 and 2023 was performed. Depending on the type of treatment, 2 groups were formed: control and treatment. The control group included 20 patients who underwent surgery with a polymer mesh, the treatment group included 20 patients who underwent surgery with a titanium mesh per the technique proposed by the authors (patient No. 2791407). The groups were matched per sex, age, and follow-up duration. The risks of type I and IV complications per the International Society of Limb Salvage 2014 (ISOLS 2014) classification and functional results per the Musculoskeletal Tumor Society Score (MSTS) scale were evaluated. Additionally, the angle of deficit of active knee joint extension was measured.

Results. In the retrospective part of the study, significant differences (p = 0.004) were found in probability of type I complications: the use of polymer and titanium meshes as additional fixation aids for attachment of the extensor mechanism to the endoprosthesis significantly decreased the probability of this type of complications. Functional evaluation per the MSTS scale showed that the use of additional fixation aids for attachment of the extensor mechanism to the endoprosthesis (both titanium and polymer meshes) significantly improved functioning of the limb (p <0.001). In the prospective part of the study, significant differences were found in the probability of extensor mechanism failure (p = 0.020): the use of titanium meshes decreased the probability of failure. In the patient group involving titanium meshes, functional results 12 months after surgery were significantly better than in the group with polymer meshes (p <0.001). Evaluation of the deficit of active knee extension did not show significant differences between the groups (p = 0.160).

Conclusion. The use of titanium mesh as an additional fixation aid for the preserved elements of the extensor mechanism showed good results both in primary and revision oncologic endoprosthesis of the knee joint. Titanium meshes can be recommended for use in clinical practice, but formulation of the final conclusions requires more clinical material and longer follow-up duration.

Introduction. Currently, a personalized approach is considered a priority in the treatment of malignant neoplasms of bones, skin and soft tissues. The decision on the treatment plan is formed by a multidisciplinary team of specialists: a surgeon, a chemotherapist, a radiotherapist. The active introduction of systemic therapy and new technologies in radiation therapy made it possible to ensure local and systemic control of the disease, which contributed to the expansion of indications for performing organ-preserving surgical interventions. In order to improve functional results, while observing the radicality of the intervention, the restoration of integumentary tissues, as well as anatomical structures, is carried out. According to various authors, the need for a reconstructive plastic component in surgical interventions on the musculoskeletal system and skin is 28–32 % for segmental resections of long bones, 30–42 % for operations on pelvic bones, 50–80 % for soft tissue sarcomas, 80 % for operations on the chest wall, when the skin is heated – 44,7 %.

Aim. To study and present the results of combined treatment with reconstructive plastic surgery in patients with tumors of bones, skin and soft tissues.

Materials and methods. The results of treatment and follow-up of 441 patients with locally advanced tumors of the skin, bones and soft tissues who received treatment in Republican Clinical Oncological Dispensary named after Prof. M.Z. Sigal from 2016 to 2023 were analyzed. The patients underwent surgical treatment with the implementation of the reconstructive plastic stage.

Results. In accordance with the principles of a personalized approach, a method of reconstruction of a postoperative defect was chosen for all patients, taking into account the localization of the pathological focus, the volume of surgical intervention, and somatic status.

Conclusion. Performing the reconstructive plastic stage in the surgical treatment of tumors of bones, soft tissues and skin is characterized by a low number of postoperative complications and good functional results, significantly reducing the risk of tumor recurrence and systemic progression due to compliance with the radicality of the intervention.

Soft tissue sarcomas are a rare and heterogeneous group of solid tumors originating from the mesenchyme and accounting for only 1 % of all malignant neoplasms in adults. The modern clinical and morphological World Health Organization of soft tissue sarcomas classification includes more than 100 forms of these tumors. Neurofibromatosis is a group of hereditary, autosomal dominant diseases characterized by the development of multiple tumor formations, often benign. Currently, there are 3 types: neutrophibromatosis type I, neurofibromatosis type II and schwannomatosis. The estimated risk of developing sarcoma in patients with neurofibromatosis type 1 at age 30 years is 25.1 %, and by age 50 years it is 38.8 %. Treatment of soft tissue sarcomas associated with neurofibromatosis fully complies with the standard recommendations of National Comprehensive Cancer Network, NCCN (NCCN), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO) and RUSSCO and does not have its own peculiarities. Over the past 15 years, at the A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, more than 190 patients with locally advanced, high-grade soft tissue sarcomas have been treated, including five patients with sarcomas associated with neurofibromatosis. The article presents clinical cases of treatment of soft tissue sarcomas associated with neurofibromatosis.

Angiosarcoma is a rare, aggressive tumor arising from the endothelial cells of blood vessels that can affect internal organs, but the most common location is the skin. The article presents current data on the molecular genetic profile, diagnosis and treatment of primary and secondary angiosarcomas of the breast. A search for relevant sources was carried out in the PubMed, Cochrane Library and eLibrary systems, publications from 2012 to 2023 were examined, 29 of which were used to write this review.no standard treatment guidelines, and the optimal approach remains surgical resection to achieve negative resection margins. The role of neoadjuvant, adjuvant chemotherapy and radiotherapy remains controversial.

Introduction. Melanoma is one of the most aggressive skin tumors, which occurs against the background of malignant transformation and proliferation of melanocytes. Risk factors for the development of cutaneous melanoma are solar radiation and duration of exposure, old age, individual patient characteristics (light skin, a large number of nevi, including atypical ones, family history) and others. Research in recent years shows that this disease is associated with a number of genetic changes, both congenital and acquired.

Aim. To study the frequency of occurrence and prognostic significance of the V600E mutation in the BRAF gene in stage I skin melanoma.

Materials and methods. The study was retrospective in nature and included 88 patients with stage I cutaneous melanoma (pT1–2aN0M0). All patients underwent a sentinel lymph node biopsy and no metastases were detected in it (pN0). All patients underwent molecular genetic analysis of the tumor to identify the V600E mutation in the BRAF gene with further assessment of the effect on the progression of early skin melanoma in cases of its detection.

Results. The median follow-up time for patients was 32.5 (12–214) months. In 25 (28.4 %) patients of the total sample, the V600E mutation in the BRAF gene was detected. Melanoma progression during follow-up occurred in 23.9 % of patients: 44 % with the V600E mutation in the BRAF gene and 15.9 % without it (p = 0.012). In patients with this mutation, regional metastasis was more often observed, with a predominant localization of distant metastases in the bones. Survival rates were significantly higher in patients without a mutation in the BRAF gene: 1-year disease-free survival of patients without a mutation in this gene was 95 %, 3-year – 87%, 5-year – 65 %, in patients with this mutation – 84, 57 and 37 % respectively. According to the results of Cox regression analysis, in the presence of a mutation in the BRAF gene, there was an increase in the risk of progression to stage I cutaneous melanoma by 2.973 times (p = 0.016).

Conclusion. The V600E mutation in the BRAF gene occurs in 28.4 % of patients with stage I cutaneous melanoma and is an unfavorable prognostic factor for disease progression.

Primary cardiac osteosarcoma is an extremely rare malignant tumor, its incidence is less than 10 % of all primary cardiac sarcomas. Currently, less than 100 cases of this disease have been reported, and there is no consensus on the optimal approaches to treatment. The article presents a clinical case of primary cardiac osteosarcoma noting the effectiveness of two chemotherapy lines and describes difficulties in tumor morphology interpretation.

The article presents a clinical case of diagnosis and successful surgical treatment of a giant epidermoid cyst of the anterior surface of the neck with an unusual magnetic resonance pattern in the form of calibrated spherical structures. The issues of differential diagnosis of epidermoid cyst and dermoid cyst and the reasons for the formation of intracavitary spheres are addressed