Osteoid osteoma is a rare benign osteogenic bone tumor without malignant potential causing severe night pain relieved by nonsteroidal anti-inflammatory drugs. Pain associated with osteoid osteoma of the spine cannot be treated conservatively and requires surgical approach. Types of surgical treatment include intralesional curettage, marginal resection, or en bloc tumor resection. However, absence of clear intraoperative visualization of the lesion often leads to excessive resection of vertebral structures requiring additional bone reconstruction and fixation with metal structures. In some cases, due to incorrect choice of resection area and segment level, repeat surgeries are performed causing secondary spinal deformations, worsening patient’s condition, and increasing economic expenditures. Currently, minimally invasive methods of transcutaneous treatment of osteoid osteomas such as interstitial laser ablation, cryotherapy, and radiofrequency thermal ablation are becoming more prominent. Aim. To evaluate the effectiveness of radiofrequency thermal ablation treatment in patients with osteoid osteoma. Materials and methods . The prospective study included 12 patients with osteoid osteoma of the spine. Their quality of life was evaluated using the Short Form-36 (SF-36) questionnaire prior to radiofrequency thermal ablation and 30, 90 and 180 days after. At the first visit and during observation, pain syndrome intensity was measured using the Visual Analog Scale (VAS) and R.G. Watkins scale for objective evaluation of pain syndrome per number of analgesics administrations. Results. Follow-up duration varied between 12 and 36 months. In all clinical cases, general, physical, and psychological health improved 2–3-fold. Pain intensity at day 1 after radiofrequency thermal ablation compared to mean pain intensity during the day prior to the procedure was significantly lower (р = 0.05). At the final examination, none of the patients had pain (pain syndrome intensity 0 per VAS); all patients had subjective satisfaction level of 100 %. Analgesics (nonsteroidal anti-inflammatory drugs and paracetamol) were administered on request for 8 ± 2.34 days after the procedure. Conclusion. Based on literature data and our own experience of diagnosis and surgical treatment of osteoid osteoma of the spine, we conclude that in cases of small lesions (<2 cm) in hard to access locations, computed tomography-controlled radiofrequency thermal ablation allows to perform surgical intervention safely, effectively and with minimal number of complications.

Introduction. Surgical intervention is the only or main component of combination treatment of the majority of malignant tumors of the spine. Pronounced pain syndrome and neurological deficit caused by spinal tumors significantly worsen disease progression, decrease patients’ quality of life.Aim. To develop a Russian-language version of a specialized questionnaire to study the quality of life of patients suffering from tumor lesions of the spine Spine Oncology Study Group Outcomes Questionnaire (SOSG-OQ).Materials and methods. In 82 patients with tumors of various parts of the spine who are treated at the N.N. Blokhin National Medical Research Center of Oncology, psychometric evaluation of the SOSG-OQ questionnaire was performed confirming its convergent validity and reliability–consistency (Cronbach’s α = 0.899).Results. Exploratory factor analysis confirmed adequacy of the questionnaire’s structure and its conformity to the basic factor model. Instruments of the validated Russian version of the SOSG-OQ questionnaire (text and data analysis instructions) for its use in clinical practice are presented. Results obtained using the new SOSG-OQ questionnaire show a significant decrease in quality of life of patients with spinal tumors. Additionally, after surgery patients described their health-related quality of life significantly higher than prior to treatment.Conclusion. Validated Russian version of the SOSG-OQ questionnaire can be recommended for application in oncological clinic for more precise and differentiated evaluation of performance status, emotional condition, experience of patients, evaluation of life circumstances associated with the disease to promote more targeted and personalized psychological care.

Tumors of the chest wall are a heterogenous group of neoplasms per nosology, clinical progression, and treatment methods. Primary tumors of this location, according to some authors, comprise between 1 and 5 %, and 60 % of them are malignant. Tumors of the chest wall can have not only various nosological forms but also varying volume, location, affect different structures of the chest wall which are determined during physical exam. Despite the progress in drug therapy, radical surgical intervention is a prerequisite for successful treatment of patients with malignant tumors of the chest wall. One of the most important prognostic factors is sufficient margin during chest wall resection. The international tumor classification system Tumor, Nodus and Metastasis (TNM) does not give a complete understanding of the volume of lesions and therefore does not allow to correctly plan resection volume and defect reconstruction based on its data. The article presents a classification of tumor volume of the chest wall proposed by the Sarcoma Research Association which allows to expand indications for surgical treatment and select the optimal type of defect reconstruction.

Introduction. Neurofibromas developing in neurofibromatosis type 1 rarely grow to a large size. However, in cases of massive lesions, selection of optimal treatment tactics can be complicated. Clinicians usually resort to surgical treatment which currently serves as an effective instrument for improving patients’ quality of life and for achieving good cosmetic results.Aim. To describe a successful experience of surgical treatment in a patient with giant neurofibroma type 1 affecting a massive pool of soft tissues.Clinical case. Patient, 22 years, sought medical help at the N.N. Blokhin National Medical Research Center of Oncology with diagnosis of neurofibromatosis type 1 with massive lesions in the tissues of the lower third of the back, gluteal region, thighs. The disease has existed since birth, family medical history is fraught: father died of malignant manifestation of a neurogenic tumor. The younger sister is also diagnosed with neurofibromatosis affecting the brain and manifesting through cafe au lait spots on the body. Due to massive tumors significantly decreasing the patient’s quality of life, cytoreductive surgical treatment was prescribed aimed at maximally radical resection of all available tumors to alleviate the patient’s condition.Conclusion. The presented clinical case demonstrates successful experience of surgical treatment of a patient with giant neurofibroma affecting a massive pool of soft tissues.

Introduction . Giant cell tumor of bone is a relatively rare, locally aggressive osteolytic skeletal neoplasm with uncertain behavior: recurrence rates up to 70 % and distant metastases occur 2–6 % of cases. Nowadays denosumab is the choice of therapy for patients with unresectable or advanced disease. However, the efficiency, duration or administration and most of all safety of continuous denosumab are not established. Materials and methods . Fourty advanced or unresectable giant cell tumor cases were observed from 2005 till 2020 in N.N. Blokhin National Medical Research Center of Oncology. The average age of pts was 33,6 ± 13,1 years (18–64), and the women and men ratio was about 2,1 : 1. The most commonly affected sites were long bones of the lower extremities (22,5 %), sacrum (22,5 %), long bones of the upper extremities (17,5 %), spine (17,5 %), pelvis (10 %) and others. 70 % of cases were anatomically compounded due to tumor localization and 27,5 % of cases were primary disease. 37,5 % of cases were with pulmonary metastases. Patients underwent computed tomography / magnetic resonance imaging every 3 months during the first three years and then once every six months. Patient received subcutaneous denosumab 120 mg every 4 weeks with a loading dose of 120 mg subcutaneous on study days 8 and 15. After 2 years monthly therapy and confirmed stabilization effect patient then received maintenance therapy: once in three months injection. All patients received daily calcium and vitamin D supplement. Results . Median follow-up was 52,8 ± 41,3 months (3–219 months). The average denosumab injections were 25 ± 16 (4–85). Clinical and radiographically stabilization of the effect occurred on average at 12 ± 8 (4–32) injections. Hypocalcemia was registered in one case (2.5 %). There was significant improvement of Karnofsky scale, Visual analogue scale (VAS) and Watkins scale (p <0.001). 5-year progression-free survival for was 70.1 % (95 % confidence interval 55.7–88.0), the median was not reached. Progression of disease was observed only in subgroup with violations in denosumab administration or its cancellation (32,5 %). 3-year progression-free survival in subgroup with violations in denosumab administration or its cancellation was 10 % (95 % confidence interval 15.5–64.1). In subgroup with continuous denosumab and once in three months injection after 2 years monthly therapy there was no signs of progression. Conclusions . In this study we showed evidence of safety and effectiveness of continuous denosumab for unresectable or advanced giant cell tumor even with once in three months injection therapy. Denosumab for advanced giant cell tumor of bone became a choice of treatment, but we need further investigation for observation long term denosumab effectiveness and complications.

Introduction . Enzyme-linked immunosorbent assay of biochemical markers is one of the most important methods for diagnosing tumors. One of these markers is an inducer of expression of matrix metalloproteases EMMPRIN/CD147. Changes in its expression are associated with the progression of some tumors. This study is the first work devoted to the study of the content of the soluble form of the transmembrane glycoprotein EMMPRIN (sEMMPRIN) in the blood serum of patients with various bone tumors. Aim . To study the content of sEMMPRIN in the blood serum of patients with malignant bone tumors, its relationship with the clinical and morphological characteristics of neoplasms and prognosis. Materials and methods . The study included 88 patients with malignant tumors (osteosarcoma – 37 cases, chondrosarcoma – 39, chordoma – 5, Ewing’s sarcoma – 7) and borderline (11 cases) bone neoplasms, of which 14 patients were under the age of 18 years. The control group consisted of 29 healthy donors, 8 of which were under the age of 18 years. The concentration of EMMPRIN was determined in the serum of patients and donors with reagents for direct enzyme immunoassay “Human EMMPRIN” (R&D, USA) in accordance with the manufacturer’s instructions and expressed in nanograms (ng) per 1 ml of blood serum. The obtained data were processed using the GraphPad Prizm 9.4 program. When comparing indicators and analyzing their relationships, we used the nonparametric Mann–Whitney and Kruskal–Wallis tests. Overall survival was analyzed using the Kaplan–Meier method. Results . Our analysis of the sEMMPRIN content in the blood serum of patients with bone tumors did not reveal statistically significant differences between the control group and patients with borderline and malignant tumors, both in adults and in children. At the same time, a trend towards a decrease in the level of sEMMPRIN in the blood serum was noted in the presence of a malignant neoplasm of the bone compared with the corresponding control group. Additionally, we found that the content of sEMMPRIN is associated with age and higher in the group of patients under 18 years of age, both among healthy donors and oncological patients. An analysis of the association of sEMMPRIN content with clinical and morphological characteristics did not reveal statistically significant patterns, however, a trend towards an increase in the level of the marker with disease progression in both studied age groups was observed, which is consistent with other studies conducted on other solid tumors. Conclusion . ELISA revealed the marker sEMMPRIN in the blood serum of all examined children and adults with borderline malignant bone tumors and healthy donors. At the same time, the levels of sEMMPRIN did not differ between the above groups, however, there was a tendency for a decrease in the concentration of the marker in patients with bone sarcomas compared with the control group, regardless of age.

3D printing has opened new opportunities for the development of personalized systems for prosthetics of extensive chest wall defects after radical surgical interventions for malignant tumors. However, risk factors for an adverse outcome of such operations have not yet been identified. Clinical cases . A 65-year-old man with primary chondrosarcoma of the V rib, underwent surgical resection of three ribs, plasty with local tissues, and an individual 3D printed titanium implant was installed on the sternum and IV-VI ribs. Follow up for 26 months showed no complaints or signs of recurrence. A 52-year-old woman with radiation-induced soft tissue sarcoma of the chest wall, that developed 9 years after radiation for breast cancer, underwent resection of four ribs and pectoral muscles and a 3D printed titanium implant was installed on the sternum and II-V ribs. The operation was complicated by the marginal necrosis of the soft tissue flap and infection of the endoprosthesis, which required removal of the metal structure and reconstruction using TRAM flap. After 9 months, a local recurrence of the tumor was diagnosed. Discussion. As a factor of a positive outcome in a man should be noted a thick layer of subcutaneous fat with muscle tissue, due to which plastic surgery was performed, covering the defect without tension. An extensive resection of the pectoral muscles in a woman created a tissue deficit. Another factor of an unfavorable outcome can be considered the radio-induced nature of the sarcoma. Further research is needed to improve the strategy for selecting patients with malignant tumors of the chest wall for prosthetics.

Introduction. Primary spinal osteosarcoma and rare metastatic heart lesion are considered significant factors for poor prognosis. The available work indicates that combined treatment, including the radical surgery of heart solitary metastatic lesion, probably provides the best outcome.Case report. Man, 27-year-old, with Th8 spinal osteosarcoma and solitary left atrial metastasis. From October 2019 to February 2020 5 cycles of chemotherapy (high doses of platinum and doxorubicin) were carried out with positive effect. Next steps were surgery: March 2020 – spondylectomy of the Th8 vertebra with combined stabilization; September 2020 – subtotal resection with plasty of the right atrium, tricuspid valve and prosthesis of the right coronary artery. Between the first and second surgery, 4 more same chemotherapy cycles were carried out. Currently, 24 months after completion of treatment, there are no signs of the disease.Conclusion. The article presents a unique case of treatment of primary osteosarcoma and metastatic lesion of rare location. Multidisciplinary approach and combination treatment in specialized centers increase the probability of favorable outcome in such cases.

Introduction. Malignant peripheral nerve sheath tumors (MPNSTs) belong to a rare heterogeneous group of aggressive neoplasms of mesenchymal origin. The relationship between the PD-L1 expression and development and prognosis of MPNSTs has not yet been determined. In addition, it is yet to explore the role of tumor microenvironment, in particular tumor-associated macrophages, in solid tumors. The aim of the study was to determine the relationship between (1) PD-L1 expression and the nuclear marker of PU.1 expression in stromal cells and (2) overall survival (OS) and recurrence-free survival (RFS) in patients with MPNSTs. Materials and methods. The retrospective study included 46 adult patients with MPNSTs who underwent surgical or combined treatment from 1998 to 2021 at the N.N. Blokhin Oncology Research Center. We analyzed clinical and morphological parameters as well as the outcomes of surgical treatment. Immunohistochemistry was used to detect the expression of PD-L1, PU.1, and Ki-67. Results. We found positive PD-L1 staining in 28% of cases. PU.1 expression was observed in all samples. We showed a statistically significant correlation between PU.1 and PD-L1 expression levels. At a median follow-up of 37 months, PD-L1 positive status was associated with a lower median OS and RFS in the group of patients with grade III tumors (p=0.0003 and p=0.004, respectively). The median OS for tumors with high and low number of PU.1+ cells was 21 and 78 months, respectively (p<0.0001). Conclusion. To the best of our knowledge, this is the first study to describe the prognostic value of the macrophage marker PU.1 in patients with MPNST. High levels of PU.1+ cells, regardless of the tumor grade, and PD-L1 expression >1% of tumor cells in the patients with poorly-differentiated MPNSTs, produced a negative effect on OS and RFS. The analyzed expression of these markers can be used in prognostic tests and developing novel therapeutic treatment options. Keywords: malignant peripheral nerve sheath tumor, PD-L1 immunohistochemistry, PU.1, surgical treatment

Introduction.The results of using various reconstructive technologies in the 1980–1990’s to replace post-resection bone defects determined oncological endoprosthetics as the most promising onco-orthopedics trend, due to the quality-of-life and functional potential restoration in a short time. Despite the constant improvement of the design and technology of oncological endoprosthesis at the moment, complications such as aseptic instability, mechanical failure and infection of the endoprosthesis significantly affect the reduction of implant survival. It is impossible to reduce the frequency of endoprosthesis aseptic instability without developing a unified strategy for the prevention and treatment of this type of complication.The study objective – to examine the main causes of early and late aseptic loosening, analyze complication rate in various periods after endoprosthesis using literature data and results of treatment of a large patient group who underwent primary and repeat endoprosthesis for different post-resection bone defects.Materials and methods. The study included 1292 patients aged 10 to 81 years with primary bone and soft tissues sarcomas, metastatic, benign lesions of the bone, who since January 1992 to January 2020 were performed 1671 primary and revision endoprosthetics of various bone segments. The age of the patients ranged from 10 years to 81 years. The mean age of the patients was 34.7 years. In the study group of patients, most often endoprosthetics was performed at the age of 21 to 30 years and accounted for 29 % of cases. The mean follow-up period after primary arthroplasty of various segments was 82.8 months (from 0 to 335.7 months). The mean follow-up period after revision arthroplasty was 54.2 months (from 0 to 282.8 months). In 1594 (95.4 %) cases were used bone cement stem fixation.Results. The results of the study show that the optimal shape of the endoprosthesis stem for primary and revision endo-prosthesis replacement is conical and cylindrical figured (made in the shape of the bone marrow canal). The most stable endoprosthesis stems are 60–100 mm long for upper limb arthroplasty and 110–150 mm for lower limb arthroplasty. Endoprosthesis stems longer than 160 mm can only be used in revision endoprosthetics. The length of the bone resection does not affect the incidence of endoprosthesis instability. The quality of the formed cement mantle affects the frequency of endoprosthesis instability. The presence of at least one revision arthroplasty with replacement of the endoprosthesis stem increases the risk of developing subsequent early instability (type IIA) about 4 times and the risk of late instability (type IIB) about 6 times compared with primary arthroplasty. The occurrence of late aseptic instability of the endoprosthesis (type IIB) will lead to the development of breakage/destruction of the endoprosthesis (type IIIA) in a shorter period than the breakage/ destruction of the endoprosthesis will lead to the development of late instability of the endoprosthesis (type IIB).Conclusion. The choice of an endoprosthesis, taking into account the optimal biomechanics of the endoprosthesis design, the shape of the stem, methods of fixation, the introduction of innovative technological solutions, adherence to the principles of oncological endoprosthesis replacement, is a means of reducing the incidence of this type of complications.

In this study we analyzed the quality of life in 62 patients (35.5 % of men and 64.5 % of women; mean age 55 years) who had tumor lesions in different parts of the spine and were treated in the Department of Vertebral Surgery, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russia. We assessed the association between the quality of life and psychological characteristics of patients – coping strategies and personal resources. We used a general questionnaire for assessing patients’ quality of life (The Medical Outcomes Study Short Form 36 Items Health Survey) and special questionnaires for cancer patients (Quality of Life Questionnaire – Core 30, QLQ-C30), patients with tumor lesions to the spine (Spine Oncology Study Group Outcomes Questionnaire, SOSG OQ), and psychodiagnostic methods, such as Ways of Coping, Big Five, and Life-meaning Orientations. We have identified an association between the quality of life and all parameters of psychodiagnostic questionnaires, better quality of life correlated with more pronounced psychological characteristics reflecting the maturity of the individual (internality, activity, presence of meaningful goals, ability to seek social support, etc.). Lower personal maturity and poorer constructive coping strategies were associated with worse somatic symptoms and their impact on the quality of life.

Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

Introduction. Radical surgical resections in the treatment of malignant tumors of the spine have proven effective in improving both overall and disease-free survival of patients. Indications for such interventions are primary malignant tumors of the spine, primary benign tumors with aggressive growth, and solitary metastatic lesions in patients with a favorable oncological prognosis. Due to the anatomical features of the vertebral column, it is very difficult to perform radical resections. An even more difficult task is to perform such interventions for multilevel spinal lesions. The study objective is to evaluate the results of radical surgical treatment for multilevel tumor lesions of the spine. Materials and methods. From 2004 to 2019, in the department of spine surgery of the N.N. Blokhin National Medical Research Center of Oncology treated 36 patients with spinal tumors, who underwent multilevel radical resections. The analysis of this surgical treatment of patients with multilevel neoplastic lesions of the spine was carried out. Results. Performing radical surgical interventions on the spine makes it possible to reduce the frequency of local relapses, improve functional results and overall survival of patients. After performing multilevel resections, complications often occur.

Relevance. The relevance is determined by the need to study quality of life over time in patients with spinal tumors during surgical treatment, as well as to study relationships between quality of life and psychological characteristics, including those responsible for adaptation to a disease, i.e. coping mechanisms (coping strategies and resources). Intention. To study the dynamics of the main quality-of-life parameters in patients with spinal tumors in the perioperative period, as well as to assess relationships between quality-of-life parameters and the psychological mechanisms of disease-related stress coping. Methodology. Quality-of-life parameters were studied over time (before and after surgery) in 62 patients with various spinal tumors (average age 55 years; 22 males [35.5 %]) treated at the Department of Vertebral Surgery of N.N. Blokhin National Research Center of Oncology. The relationships were studied between patients’ quality of life in the early postoperative period and their disease-related stress coping strategies and resources. The following tests were used: the 36-Item Short Form Health Survey Questionnaire (SF-36), questionnaires for studying Quality of Life in oncological disease (QLQ C-30), spine tumors (SOSG OQ), the Ways of Coping Questionnaire (WCQ), the Big Five Personality Test and the Purpose-in-Life Test. Results and Discussion. 23 of 29 studied quality-of-life parameters improved statistically significantly or tended to improve in the post- vs preoperative period, including the general index of health and quality of life, physical, emotional, social and cognitive activity, as well as symptoms of somatic distress (except an increased index of neurological dysfunction). Relationships were revealed between quality-of-life parameters and all the coping-related psychodiagnostic indices (except the “Extraversion” scale). Higher quality-of-life indices positively correlated with mature personality (internality, activity, meaningful goals, seeking social support, etc.). Less mature personality and less effective coping strategies were associated with more pronounced somatic symptoms and their impact on the quality of life in patients. Conclusion. The results of this study can help develop more targeted and individualized programs of psychological assistance and social rehabilitation for patients with spinal tumors.

Background. The standard treatment for giant-cell tumors of the bone includes radical surgery. However, specific anatomical location of the tumor and/or its spread may hinder its complete excision or result in poor functional outcomes. Currently, combination treatment that includes preoperative denosumab and surgery is preferable. It saves patients’ lives and improves their quality of life. Reduction of local recurrence rate by combination therapy for giant-cell tumors of the bone is being actively studied now.Objective – to analyze treatment outcomes of patients with giant-cell tumors of the bone, including those who received combination treatment that included preoperative therapy with denosumab followed by surgery.Materials and methods. This study included 277 patients with giant-cell tumors treated in N.N. Blokhin National Cancer Research Center between 2005 and 2020. The mean duration of follow-up was 56 months. Study participants were divided into two groups. Group 1 included patients who received surgical treatment alone (n = 212), whereas Group 2 comprised patients who received combination treatment (n = 65). Neoadjuvant therapy included subcutaneous denosumab 120 mg on days 1, 8, 15, and 28, then every 4 weeks until stable effect. There were two variants of surgical treatment: radical (removal by a single block or segmental resection with defect replacement, with or without fixation) and non-radical (excochleation or marginal resection with defect replacement, with or without fixation).Results. During treatment, patients in Group 2 had a significantly milder pain syndrome (assessed both using the visual analog scale for pain and Watkins scale) compared to Group 1. In case of radical surgery, the incidence of local recurrence was 12 % and 0 % in Groups 1 and 2, respectively; the difference was significant (р <0.05). Tumor location and volume of surgery played an important role in disease recurrence (р <0.05). The incidence of complications after radical surgery was 36.9 % and 12.5 % in Groups 1 and 2, respectively; the difference was significant (р <0.05). In addition to that, neoadjuvant therapy with denosumab substantially reduced the duration of surgery and blood loss in patients with challenging anatomical location of the tumor (р <0.05).Conclusion. Combination treatment for giant-cell tumors that includes neoadjuvant therapy with denosumab reduces the risk of recurrence, duration of surgery, blood loss, and the risk of postoperative complications. However, it is important to consider tumor location and the volume of surgery. Since the disease is quite rare, further study of long-term efficacy and safety of combination treatment for giant-cell tumors, including rare ones and those with challenging anatomical location, is necessary.

The article is devoted to description of psychological assistance program in oncoorthopedic clinic, based on the results of studying psychological characteristics and dynamics of the main parameters of quality of life in patients with oncoorthopedic pathology.The main stages of complex psychological assistance are presented, approaches to psychodiagnostics in oncoorthopedic clinic are proposed. The main directions of psychological assistance for patients with bone tumors are identified and substantiated.

Objective. The aim of this study is to improve the results of surgical treatment of lung metastases of soft tissue sarcomas, to analyze the factors that may affect the effectiveness of surgical treatment.Materials and methods.The study included 80 patients with metastases of bone sarcomas in the lungs, who received treatment in the period from 2000 to 2013. Among the patients there were 42 (48,5 %) men and 38 (51,5 %) women.The median age at diagnosis was 33 years (range 17 to 75). The majority of soft tissue sarcomas were represented by malignant fibrous histiocytoma (27,5 %) and synovial sarcoma (28,5 %). Almost all patients (96 %) underwent chemotherapy before surgery for lung metastases. The indication for surgery in most cases (52,5 %) was metastases in the lungs as the only manifestation of the disease. Most often, operations were performed with unilateral lung lesions (67,5 %).Results. Atypical lung resections 58 (72 %) were the most frequently performed volume of surgical intervention, pneumonectomy, bilobectomy and lobectomy were used in 17 (22 %) cases. Combined resections were performed in six patients. Postoperative complications were observed in 6 (7,5 %) patients. The radicality of the operations performed in the study group was 93 % in the R0 volume, in the R1 volume, 4 % of the operations were performed, in the R2 volume, 1 patient was operated on. The most frequent postoperative complication was pneumonia, one patient died in the early postoperative period from complications of surgery. The median follow-up in the study group was 49,2 months (from 3,5 to 239 months). The overall 5-year survival rate in the study group was 41,5 %. Five-year overall survival was more than 30 % higher in the group of patients who had less than 3 metastatic lesions at baseline. Only the following factors have a direct impact on OS indicators: the number and size of metastatic foci, radical removal of metastatic foci, the effect of previous chemotherapy, and the timing of the development of metastatic lesions. In our study, there were also no differences in OS and PFS depending on the surgical approach used.Conclusion.Surgical treatment is currently fully justified and the only really effective treatment method that can lead to longer-term survival in patients with metastases of sarcomas in the lungs, despite the fact that some metastases have a clear resistance to all types of conservative therapy, while The best treatment results are achieved in the presence of a long disease-free interval (DFI), a small number of metastases and their removal in the R0 volume.

European Organization of Research and Treatment of Cancer (EORTC) Bone Metastases (BM22), developed by the Quality of Life Assessment Group, is a specialized module of the quality of life questionnaire EORTC QLQ-C30, assessing the quality of life in patients with bone tumors. The aim of the study is to develop its Russian version. The study included a sample of 139 patients with bone tumors - inpatients of N.N. Blokhin Cancer Research Center. The scale has a good convergent validity and internal consistency (0,871), factor analysis confirmed the structure of the scale and its compliance with the original model. The results revealed significant decrease in quality of life due to patients' focus on pain and its severity. We conclude by drawing out the main directions of psychological aid to patients with bone tumors.