The article presents a rare clinical observation of the surgical treatment of a 66-year-old patient with recurrent chondrosarcoma of the left iliac bone. Resection of the left iliac bone following reconstruction of the pelvis with an individual 3D-printing endoprosthesis was performed. The article also describes all process of operation and early outcome.

Background. Numerous studies have proved the participation of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in the pathogenesis of diseases of various etiologies, including in tumor transformation, as well as in the processes of invasion and metastasis. The involvement of TIMP-1 and TIMP-2 in the processes of growth and progression of osteosarcoma was demonstrated in the U-2OS, MG-63 and OS-732 cell lines. There are small amount of clinical studies for bones tumors, but they show differences in expression of MMP and TIMP in the tumor and surrounding tissues, both in borderline and malignant bones tumors. Aim of the study. The study of the content of tissue inhibitors of MMPs TIMP-1 and TIMP-2 type in the most accessible biological material - the blood serum of patients with primary malignant and borderline neoplasm of bones and apparently healthy people of the corresponding age to identify a possible relationship with the morphological tumor’s structure and the prognosis of the disease. Materials and methods. 128 patients with bone tumors (69 men and 59 women) and 42 apparently healthy donors of the corresponding age were examined. The diagnosis of all patients, t was established for the first time and confirmed by histological examination of the tumor. Malignant bones tumors were diagnosed in 108 (84%), borderline bones tumors - in 20 (16%) patients. The studies were performed by an enzyme immunoassay TIMP-1, TIMP-2 in the blood serum of patients before the start of a specific treatment with the help of ready-made reagent kits of the firm «R&D» (USA). Results. In patients with malignant and borderline bone tumors, significantly higher concentrations of TIMP-1 and TIMP-2 were found in the blood serum than in the control, independent of the stage of the disease, histological structure, degree of differentiation and tumor localization in bones of various structures. According to the multivariate analysis, the threshold levels of TIMP-1 greater than 343 ng/ml and TIMP-2 greater than 120 ng/ml can be considered as significant and independent factors predicting the overall survival of patients with bone sarcomas. Conclusion. The obtained results testify to the prospects of further study of TIMP-1 and TIMP-2 in peripheral blood at bones neoplasm for study the possibility of using them as markers of disease prognosis.

It is believed that the main factors determining the prognosis of cancer are the prevalence and degree of differentiation of the tumor. In recent years, more and more attention has been paid to genetic factors that determine the individual risk of developing cancer, as well as participate in the processes of carcinogenesis in general. Therefore, the study of molecular-biological tumor markers, which are specific indicators of the high risk of tumor progression and the relationship to treatment efficacy, has acquired clinical significance. Objective. To study the effectiveness of treatment of patients with osteosarcoma depending on the change in expression of the p53 gene. Materials and methods. Under supervision were 221 patients with osteosarcoma. Patients received various types of treatment. Neoadjuvant polychemotherapy (PCT) was performed in 184 (83,2%) patients, of which 131 (71,2%) patients underwent systemic neoadjuvant CT, and 29 (15,7%) patients underwent prolonged intra-arterial regional chemotherapy (PIRC). A combination of systemic PCT and PIRC was performed by 24 (13%) patients. Immunohistochemistry (IHC) was performed by avidin-biotin-peroxidase test using primary antibodies (Dako, Novocastra™) to mp53 as a gold standard procedure. Results. Analysis of the obtained data allow establishing that expression and overexpression of mtp53+ occurs in patients with osteosarcoma with a low degree of tumor differentiation (G₃) 9 times more often. In patients with stage 3 and 4 clinical stages of osteosarcoma, the positive response of mtp53+ was 4-fold higher compared to patients with 1-2 stages. Achievement of complete morphological regression during IHC was revealed in 13% of patients, among them in 70,6% of patients the expression of mutant p53 gene was absent. At 15,7% after the use of the PIRC scheme, complete morphological regression was observed, in 87,5% of these patients the mutant p53 gene was also absent. The conclusion. High and average expression of the mutant p53 gene in patients with OS has an associative relationship with a low degree of tumor differentiation (G₃) with stages 3 and 4 of the tumor process, with a large tumor size, low therapeutic pathomorphism (1 and 2), with a chondroblastic histological variant and osteolytic radiological form. The decrease in the timing of relapses, distant metastases and life expectancy in patients with mild and high expression of the mtp53 gene was found, regardless of the therapy.

It performed the analysis of literature data on assessing cancer prognosis possibilities in patients with spine metastases. Surgical intervention for metastatic spinal lesions is palliative, but the majority of patients who undergo local treatment of a given volume in combination with systemic therapy, have improved their quality of life. It is noted that the adequate determination and use of prognostic factors in clinical practice in the planning of surgical treatment helps to determine spinal surgery volume and assess the life expectancy in this patients. It described the developed prognosis systems (Tokuhashi, Sioutos, Tomita, Van der Linden, Bauer), and it is indicated that these scales differ depending on the parameters included in them and do not take into account the options for systemic treatment of a malignant disease and the presence of mutations in the tumor. It was concluded that the treatment of spinal metastases should be individualized and multidisciplinary, the rational choice of treatment and its scope should be based on a comprehensive assessment of anamnestic, clinical and prognostic data. Accurate assessment of the postoperative survival prognosis will improve the quality of medical care for this category of patients and achieve optimal indicators of quality of life.

Objective. The problem of finding ways of adequate relief of pain in patients with cancer is actively studied in contemporary science. The question of impact of pain on quality of life in cancer patients is also studied: the prevalence and intensity of pain significantly determine the overall assessment of patients’ quality of life. The article is devoted to study psychological factors influence on quality of life parameters related to pain perception and activity restrictions in oncoorthopedics. 139 Study participants were inpatients of N.N. Blokhin Russian Cancer Research Center. The diagnoses were osteosarcoma (42 persons), Ewing sarcoma (10 persons) giant cell tumor (32 persons), chondrosarcoma (32 persons) and bone metastases (23 persons). Materials and methods. The psychological methods were: «SF-36 Health Status Survey», Quality of Life Questionnary-Core 30 of European Organization for Research and Treatment Cancer with module Bone Metastases 22, questionnaires «BIG 5», «The ways of coping» and «Purpose-in-Life Test», questionnaire of relation to disease «TOBOL». Results. The results revealed patients with metastases asses their quality of life significantly lower than other patients and asses pain characteristics as more intensive. The most widespread pain is revealed in patients inclined to behavior determined as «irritable weakness» and gloomy mood. Conclusion. The study shows the need for individual approach, taking into account the personal profile in the choice of analgesic therapy in patients with musculoskeletal tumors, especially in cases of opioids treatment.

The diaphysis of the long bones is a rare localization for malignant tumors. According to the literature, segmental resection of the diaphysis of bone with reconstruction significantly improves the patient’s quality of life. Today, there are various options for reconstruction after extraarticular resections. The present study presents the long-term results of using diaphyseal endoprostheses of various localizations. A comparative analysis was carried out, the advantages and disadvantages of alternative options for replacing the diaphysis of tubular bones were determined. International system ISOLS 2013 (Henderson) was used to determine complications of bones diaphysis endoprosthetics.

Background. Assessment of diagnostic informativeness of sentinel lymph nodes (LN) detection in primary skin melanoma (MC). Materials and methods. The results of the examination of 79 patients with MK of the trunk and extremities were analyzed; the average age was 52,9±17,4 years. Results. According to the lymphoscintigraphy, the LT sentinel was found in all patients. The sensitivity of the histological method in the determination of micrometastases MK in the sentinel lymph node (SLN) was 50%, specificity - 100%, accuracy - 88 ,3%. The low sensitivity of the method indicates the need for additional immunohistochemical studies of SLN. The diagnostic informativity of the LN biopsyin relation to the detection of MK metastases in regional LNs was: sensitivity - 87%, specificity - 100%, accuracy - 96,2%. Conclusion. SLN biopsy is a highly informative, low-impact method that allows the majority of patients to determine the stage of the disease with high accuracy and perform lymphadenectomy in the early stages with a minimum amount of metastases. Its implementation can be recommended to all patients with local forms of MK. Prior to biopsy of SLN, an indirect radionuclide lymphoscintigraphy should be performed to determine the pathways of lymphatic drainage from the primary MC, followed by static and dynamic polyposition scintigraphy to determine the topography of SLN.

We describe a case of Ewing’s sarcoma of the tibia in a 24 yearold patient and rare clinical observation with combined modality therapy including surgery with extirpation of the tibia and fibula and total endoprosthetic replacement of the lower limb.

The article describes the main clinical and biological features of TNBC, the influence of such factors as age, molecular and genetic features, androgen receptor expression level on the clinical course and disease prognosis. It describes the modern methods of treatment of TNBC.