The use of bisphosphonates in medicine began in the 60s of the XX century due to their ability to prevent the dissolution of hydroxyapatite and thereby to reduce bone loss. Since the mid-80s of the XX century, they began to be regularly prescribed for hypercalcemia. Currently, the most used bisphosphonate is zoledronic acid. Indications for its use are osteoporosis, metastatic bone damage and hypercalcemia caused by a malignant tumor. Denosumab, which together with zoledronic acid belongs to the pharmacological group of osteomodifying agents, is also used in these pathologies. Thе drug is used to treat giant cell tumour.

In the last 5 years, there has appeared the information on the use of bisphosphonates and denosumab to prevent aseptic instability, the most common complication of large joint endoprosthetics. According to the few data in the literature, significant improvement in periprosthetic bone mineral density is shown when using these drugs. Denosumab is more effective as compared to bisphosphonates. There is no reliable evidence of reduction in the risk of development of aseptic instability of the endoprosthesis with the use of bone-modifying agents. When prescribing bisphosphonates and denosumab, it is necessary to take into account adverse events associated with their use. In our opinion, using bone-modifying agents in patients after oncological endoprosthetics is reasonable in cases of high risk of aseptic instability. During primary endoprosthetics, their use should be avoided.

The aim of the work is to assess the effect of BMA on the condition of the periprosthetic bone after endoprosthesis, as well as their effectiveness in preventing aseptic instability during oncological endoprosthesis of long bones.

Introduction. Skin melanoma, despite having similar clinical and histological characteristics, can have different prognoses. Gene expression profiling potentially allows for more accurate risk stratification of patients.

Aim. To study prognostic test systems for assessing outcomes in patients with skin melanoma based on the analysis of primary tumors.

Materials and methods. A systematic literature review (scoping review) was conducted in accordance with PRISMA-ScR principles. The search was performed in PubMed (2008–2024). Two independent reviewers conducted the study selection and data analysis to assess concordance. The data were presented descriptively.

Results. Out of 149 identified publications, 31 studies were included in the review. The effectiveness of four test systems was evaluated, with the most frequently used being DecisionDx-Melanoma (19/31, 61.3%). This test stratifies patients by molecular classes: patients at high risk were found to have a 5.33 (±1.25) times higher likelihood of disease progression and poorer survival rates compared to lower-risk patients. No studies included data on the Russian population.

Conclusions. Gene expression profiling demonstrates high accuracy in predicting outcomes for patients with skin melanoma.

The article presents an analysis of publications on the effectiveness of brachytherapy in the soft tissue sarcomas. It has been shown that this method is an important part of the combined treatment of this pathology and the indications for its use are constantly expanding. The authors point to a high level of local control of the disease (from 50 to 96 % 
of cases). The greatest effectiveness of brachytherapy is observed in combination with surgical tumor removal.

Introduction. With an increase in revision surgeries for oncological knee prostheses replacement, one of the most significant challenges has been the need to address substantial intramedullary defects affecting the diaphysis and metaepiphyses in these patients. Our study is based on our experience with biological reconstruction methods used during such operations. We have developed both the methodology and necessary tools for its implementation, as well as conducted a comprehensive evaluation of its practical application results.

Aim. To assess the effectiveness of using biological bone reconstruction techniques in oncologic revision knee arthroplasty.

Materials and methods. A retrospective study included 57 patients who underwent revision total oncology knee arthroplasty with the use of biological reconstruction for intramedullary bone defects between 2017 and 2023, with a follow-up period of at least 12 months. Of these, 45 (78.9 %) were operated due to instability of the prosthetic components, while 12 (21.1 %) were treated in the second stage after spacer implantation due to infection.

Distribution of patients by location of bone defect: 26 (45.5 %) had femoral bone defects, 4 (7 %) had tibial bone defects, and 27 (47.4 %) had combined lesions involving both bones. Among the participants, 59.6 % were female and 40.4 % were male. The median age was 48 years (Q₁–Q₃) 39.00–57.00; min 23 – max 72), and the median follow-up time was 48 months (Q₁–Q₃ 28.00–60.00; min 12 – max 150). Median blood loss values were 900 ml (Q₁–Q₃ 700.0–1100.0; min 400 – max 2200), operation duration was 220 minutes (Q₁–Q₃ 190.0–240.0; min 140 – max 300), and patient weight was 85 kg (Q₁–Q₃ 77.0–95.0; min 56 – max 180).

We assessed complication risks, functional outcomes, and survival rates of the implants. All patients were divided into two groups: Group 1 (n = 37 or 64.9 %), operated before the introduction of new instruments, and Group 2 (n = 20 or 35.1%), operated after their introduction. Parameters such as operation duration and blood loss volume were compared between the groups.

Results. Over the entire observation period from 2017 to 2024, three cases (5.3%) of complications were identified. Bone density assessment in the bone graft zone was performed via CT scan six months postoperatively, yielding a mean value of 690 HU (Q₁–Q₃ 570.0 – 790.0; min 340 – max 980).Analysis of lower limb function dynamics according to the MSTS scale pre- and post-operation revealed statistically significant improvements (p <0.001) (using Wilcoxon’s test).Five-year survival rate of knee prostheses after revision arthroplasty was 96 %.To analyze the effectiveness of introducing the newly developed instrumentation, we studied blood loss and operative times with and without its use. Using the instrumentation significantly reduced blood loss (p <0.001) and operative time (p <0.001) as determined by Mann-Whitney U-tests.

Conclusion. The five-year survival rates for constructs in patients undergoing surgery with biological bone reconstruction are comparable to those observed after primary implantations of oncologic prostheses.

Introduction. The use of systemic drugs of special drug therapy in oncology is one of the key methods of treating patients including those with bone metastases. However, this does not always allow to eliminate the pain syndrome and avoid complications in the form of pathological fractures. Bone metastases often leave in the arsenal of oncologists’ mainly palliative agents, the main purpose of which is to reduce pain and improve the quality of life of patients.

Aim. To analyze the results of minimally invasive interventions in the volume of percutaneous vertebroplasty, osteoplasty and radiofrequency thermoablation.

Materials and methods. From 2015 to 2023, 488 patients on the basis of the Russian Scientific Center of Radioradiology underwent 716 interventional surgeries: 585 (81.7 %) percutaneous vertebroplastics, 103 (14.4 %) osteoplastics, 21 (2.9 %) radiofrequency thermoablasias, 7 (1 %) combined operations (radiofrequency thermoablasty + osteoplasty/vertebroplasty). Metastatic lesion was observed in 449 patients, benign tumors – in 38 (in 31 – hemangioma, in 7 – osteoid osteoma), borderline neoplasm (giant cell tumor) – in 1. Results were assessed by comparing measures of pain intensity in dependence on analgesic agents (by the visual analog scale (VAS) and Watkins scale), as well as motor activity levels (by the Eastern Cooperative Oncology Group (ECOG)) and neurological deficits (by the Frankel scale) before surgery, at the time of discharge and 3 months after surgery.

Results. In patients with metastatic bone damage 3 months after surgery, a mean decrease in the intensity of pain syndrome according to VAS was noted from 5.8 to 3.2 points, on the Watkins scale - from 7.2 to 5.7 points; ECOG functional status increased from 2.5 to 1.5 points. In 67 % of patients with neurological deficiency (class D by the Frankel scale), an increase in neurological status (class E by the Frankel scale) was observed. In all patients treated for osteoid osteoma, pain relief and restoration of functional status (0 points by the VAS and ECOG scales) were noted by the 6th month of follow-up.

Conclusion. According to the data obtained, the high effectiveness of the analgesic effect of interventional methods in patients with metastatic bone damage was noted. The use of vertebro- and osteoplasty allows to stabilize the affected segment of the skeleton (improve functional status and motor activity), and radiofrequency thermoablation – to achieve radicality of treatment in patients with osteoid osteoma.

To analyze the overall survival, mid-term, and long-term outcomes, as well as the complication structure in a group of patients after endoprosthetic replacement for soft tissue sarcomas infiltrating bone, the treatment results of 19 patients who underwent 24 primary and repeated surgeries from May 2004 to November 2021 were analyzed. The average follow-up period was 132.5 months. The average age at the time of endoprosthetic replacement was 47.7 ± 15.3 years. It was shown that the event-free survival of the operated patients after 3 years was 61.5 ± 11.5 %, after 5 years – 54.7 % ± 12.1 %, and remained at the same level after 10 years. The average time to tumor recurrence was 11 months, lung metastasis occurred at 96 months, and both recurrence and metastases were detected on average within 2 months. The overall survival of patients with soft tissue sarcomas through 3 years was 93.3 ± 6.4 %, through 5 years – 80.0 ± 10.3 %, and through 10 years – 65.5 ± 12.6 %. Across the entire group of respondents, disease progression was observed in 42.1 % of cases, tumor recurrence in 31.6 %; metastases (to the lungs) in 5.3 %; recurrence of the disease and metastases in 5.3 %. These data indicate that endoprosthetic replacement as a component of combined organ-preserving treatment for patients with soft tissue sarcomas infiltrating bone is an effective treatment method for improving the quality of life of patients, despite certain risks of disease recurrence, metastasis, and complications.

Introduction. The use of modern adjuvant drug therapy in cases of cutaneous melanoma with sentinel lymph node (LN) (SLN) metastases reduced frequency of performance of completing lymphadenectomy. However, until now, domestic and foreign clinical recommendations indicate possibility of using this procedure in patients with an unfavorable prognosis while criteria are not provided for assessing the risk of non-sentinel LN (NSLN) damage and the need to perform lymphadenectomy.

Aim. To identify predictors of high risk of metastasis in NSLN in patients with cutaneous melanoma with subclinical metastases in SLN.

Materials and methods. The study included 92 patients with clinically localized cutaneous melanoma (cT1–4N0M0), who showed subclinical lesions as a result of SLN biopsy, and therefore underwent a final lymphadenectomy.

Results. In the examined group, 26 (28.3 %) patients, along with SLN lesions, showed metastases in NSLN. Recognition of several active LNs during radionuclide mapping of SLNs is associated with a significantly higher risk of NSLN damage – in 42.3 % vs 15.2 % in the group with radiopharmaceutical activity only in SLNs (p = 0.018). Tumors thickness of >2 mm is also associated with a high frequency of NSLN metastasis (100 % of cases). No metastasis to other LNs was observed in tumor thickness of <2 mm. In ulcerated melanomas, the incidence of NSLN lesions was 92.3 % (p = 0.02). Only subcapsular localization of SLN metastases is associated with a relatively low incidence of NSLN metastasis (13.3 % of cases) as compared with parenchymal, mixed localization, and multifocal lesion (42.9 % of cases) (p = 0.002). For SLN metastases > 4 mm in size, a incidence of NSLN damage was higher than for metastases of <4 mm in size (43.3% vs 19.3%; p <0.05), as that for invasion of LN structures of > 2 mm in size versus invasion of <2 mm in size (44.4% vs 15.7 %; p = 0,003). The identified predictors of NSLN involvement in practice are often combined forming a pattern of predictors. The number of prognostic parameters in the pattern has a significant effect on the incidence of NSLN lesions (<0.001). In particular, the presence of 2 or less predictors is associated with low risk of metastasis in NSLN (0–12.5 % of cases), 3-5 predictors - with a relatively high risk (37.5–44.4 % of cases), 6 predictors – with a very high risk (80 % of cases).

Conclusion. Recognition of predictors of metastasis in NSLN and their number allows us to decide on the need to perform final lymphadenectomy in patients with cutaneous melanoma with subclinical metastases in SLN. Conducting the final lymphadenectomy in patients with a high risk of multiple lesions of regional LNs will provide better locoregional control over stage III cutaneous melanoma and will create optimal conditions for adjuvant drug therapy.

Aim. To study the expression of microRNA-16-5b, -27a, -34a-5p, -125b and -193b in melanoma tissue depending on the clinical and morphological characteristics of the tumor.

Materials and methods. The study included 21 patients with a verified diagnosis of cutaneous melanoma. The expression of miR-16-5b, -27a, -34a-5p, -125b and -193b were studied in tumor tissue by real-time polymerase chain reaction. The patients are divided into 5 groups. The group 1 included patients with a tumor <0.75 mm thick (according to the Breslow classification), group 2 – 0.75–1.5 mm, group 3 – 1.51–3 mm, group 4 – 3–4 mm, group 5 – >4 mm. The control group consisted of 10 patients with skin nevi.

Results. The expression of microRNA-27a-3p was reduced in group 5 compared to group 2 by 1.7 times. At the same time, the expression of microRNA-16-5b was, on the contrary, increased by 21.7 times in group 5 compared to groups 3 and 4. Multidirectional changes in microRNA expression were revealed when comparing parameters in groups differing in the depth of invasion. There was a 4.0-fold decrease in the expression of microRNA-27a in the group with Clark invasion III compared to the group with Clark invasion II, which was accompanied by an increase in the expression of microRNA-16-5b and microRNA-125 by 8.7 and 19.8 times, respectively. Moreover, the presence of signs of ulceration was associated with a low level of expression of microRNA-27a-3p against the background of an increase in the expression of the transcription factor microRNA-16-5b and microRNA-34a-5p.

Conclusion. Thus, the features of microRNA expression in melanoma tissue have been identified. Changes in the expression of microRNA-27a-3p, -16-5b, -34a-5p and -125b are associated with the depth of its invasion and the presence of signs of invasive growth.

Angiosarcoma is a rare malignant neoplasm that develops from endothelial cells and can affect any tissue and organ, but most commonly the skin of the head and neck. This tumor is characterized by aggressive progression and early hematogenous metastasis, which leads to an unfavorable prognosis and underscores the importance of diagnosing this pathology at its early stages. Early detection of angiosarcomas is quite challenging due to the complexity of differential diagnosis and establishing a pathomorphological diagnosis. The article presents a clinical case of treatment for locally advanced angiosarcoma of the facial skin and scalp, demonstrating the aggressiveness of this rare tumor and the relevance of its early diagnosis.

The article presents a clinical case of congenital pigmented giant nevus treatment located on the skin of the right gluteal region in a 26-year-old patient. Considering the size and localization of the nevus, we used the method of expander dermotension, which allowed us to perform surgery in 2 stages and achieve a satisfying cosmetic results.