Quality of life of patients with orthopedic oncological pathology is one of the most important indicators of therapy and rehabilitation effectiveness, a parameter important for establishment of comprehensive approach involving teamwork from doctors and psychologists. Currently, there are many instruments for quality of life evaluation in patients with various chronic diseases including oncological but a specialized questionnaire for patients with pelvic bone tumors does not exist. Nonetheless, characteristics of quality of life of patients with this pathology should be considered for optimal management of psychological and rehabilitation measures, and their dynamics can serve as criteria of treatment and rehabilitation effectiveness. Aim. To develop and test a quality of life questionnaire for patients who underwent surgery on the pelvic bones. Materials and methods . The Quality of Life Questionnaire Pelvic Bone Tumor – 30 (QLQ PBT-30) was developed and tested in 37 patients with tumors of the pelvic bones (20 (54.1 %) males and 17 (45.9 %) females) who were under-going treatment at the General Oncology Division of the N.N. Blokhin National Medical Research Center of Oncology. Mean patient age was 48.15 ± 8.95 years. Results. Psychometric characteristics of the QLQ PBT-30 (validity, reliability) are quite high. Factor analysis confirms correspondence of the factor structure of the questionnaire to the proposed key. Every question contributes to the method structure confirmed by high values of Cronbach’s α. Conclusion. Specialized questionnaire for patients who underwent surgical treatment on pelvic bones can be recommended for use in orthopedic oncology practice for more accurate evaluation of quality of life of patients with tumors of the pelvic bones.

Clinical, morpho-immunological and cytogenetic characteristics of malignancies are very polymorphic. And no less heterogeneous are paraneoplastic skin presentations arising before malignant tumour manifestation and/or proceeding in parallel. In the current literature review the most common paraneoplastic dermatosis are presented: pyoderma gangrenosa, dermatomyositis, paraneoplastic pemphigus, pityriasis rubra pilaris, Bazex syndrome, necrolytic migratory erythema, ptyriasis rotunda, Sweet syndrome. It is provided modern concepts in pathogenesis, clinical features and treatment approaches.

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.

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.

Intriduction. Hibernomas account for less than 2 % of all benign lipomatous tumors and 1 % of all lipomatous tumors. They are usually found in 20–40-year old adults (the average age of patients is 38 years). The clinical manifestations are painless soft tissue mass that are mostly slow growing; rapid growth is only found in a small number of patients. We present a case of successful surgical treatment of a pathologically confirmed rare lipomatous tumor of large size, which was located in the soft tissues of the thigh.Clinical case. A 46-year-old woman was admitted to the hospital due to a tumor 20 × 10 × 10 cm in size, that had developed 10 years ago in the anteromedial aspect of the proximal thigh. Furthermore, she had a history of hypoesthesia one month prior to her admission. During surgery, the femoral nerve was found to be compressed by the large tumor. The resultant symptoms probably caused the patient to seek medical care. Resection was performed by careful dissection, femoral nerve and vessels were spared. Histopathological examination and cytogenetics showed findings suggestive of a hibernoma. At the 6-month follow-up local tumor recurrence or metastasis was not found.Conclusions. Asymptomatic small-sized hibernoma does not require surgical resection or other treatment. When the tumor is too large and/or has the potential to compress the surrounding tissues, timely radical surgical intervention is reuired.

Introduction. The article presents the results of validation of the Russian language version of the fatigue (FA12) module of the specialized Quality of Life Questionnaire – Core 30 (QLQ-C30) developed by the Study Group of Quality of Life of the European Organization for Research and Treatment Cancer (EORTC). The questionnaire has been successfully applied in Russian and international trials.Materials and methods. A sample of 55 patients (mean age 53.23± 2.01 years; 52.7 % men and 47.3 % women) at the N.N. Blokhin National Medical Research Center of Oncology was used to perform psychometric review of the fatigue module (FA12) of the QLQ-C30 questionnaire which confirmed its convergent validity and reliability – consistency (Cronbach coefficient α is 0.768).Results. The results of factor analysis confirmed adequacy of the structure of the Russian version of the fatigue module and its conformity with the basic factor model.Conclusion. The obtained results allow to state that the Russian version of the fatigue module is a reliable and valid instrument which can be used both in national and cross-cultural trials.

Patients who face a stressful situation related to cancer and loss of a limb have not been thoroughly studied form a psychological perspective, what limits the possibilities of targeted psychological assistance and social rehabilitation. In this regard, the aim of the research was to study the clinical and psychological status, strategies and personal resources for coping with the stress of the disease, as well as the main parameters of the quality of life (QoL) of patients who underwent lower limb amputation due to cancer (group 1, n = 24, men — 62.5%, average age 47.25 ± 3.17), in comparison with patients amputated due to other somatic diseases not accompanied by an actual vital threat (group 2, n = 15, men — 93.3%, average age 59.67 ± 2.27), as well as with normative psychodiagnostic data. Methods of clinical and psychological diagnostics were used, including “Ways of Coping Questionnaire”, “Big V Questionnaire”, “Purpose in Life Test”, EORTC “Quality of Life of Cancer Patients Questionnaire” (QLQ-C30). It was found that functional capability (p<0.01), objective (p<0.001) and subjective (p<0.001) severity of pain syndrome, as well as employment (p=0.05) have the lowest indicators in group 1 compared with group 2; at the same time, the levels of QoL in both groups of patients do not differ and do not correspond the expert assessment, exceeding it; patients rate their cognitive and emotional activity most highly; the lowest, physical and role activity, and financial impact. In the structure of coping of group 1, the strategy “Seeking for social support” predominates; the values of the scales “Distancing” (p=0.05), “Escape–avoidance” (0.1<p<0.05), “Positive reappraisal” (p<0.05) are higher than in group 2, but lower than average normative values. In the personality of patients in group 1, “Conscientiousness” (p=0.01) and “Openness” (0.1<p<0.05) prevail in comparison with patients in group 2, as well as “Extraversion” (0.1<p<0.05), “Conscientiousness” (p<0.001) and “Emotional stability / Neuroticism” (p<0.05) — compared with the mean values of the test. The indicators of the scales “Meaning of life” (p<0.01), “Fullness of life” (p<0.01), “Life satisfaction” (p<0.01) in group 1 are higher than in group 2; patients’ internality is higher than in the control sample of men (0.1<p<0.05) and women (p<0.01). The results obtained can be used in the process of rehabilitation of orthopedic cancer patients.

Introduction. Computer modeling and additive technologies are increasingly used in medicine. Oncoorthopedics is no exception. Careful preoperative planning and the creation of individual instruments make it possible to perform radical operations, which allows maximum preservation of healthy tissues and leads to an increase in the functional potential of patients in the postoperative period.Objective – to improve the results of surgical treatment of patients with malignant bone tumors of complex anatomical localizations using computer modeling and additive technologies.Materials and methods. This study included 44 patients (26 men and 18 women) with malignant bone tumors. The mean age of the patients was 39 ± 15.57 years (range 14 to 66 years). In 39 cases, the anatomical location of PSI application was the pelvis, in four cases it was the distal femur, and in one case the femoral shaft. The most common histological type of tumor was chondrosarcoma (47.7 %).Results. In the case of primary resection of the pelvic bone tumor (26 patients), according to the histological examination, radical resection margins (R0) were observed in 25 cases. In one case, after removal of the tumor, a discrepancy between the preoperative histological conclusion (G2 chondrosarcoma) and postoperative (dedifferentiated G3 chondrosarcoma) was revealed. During operations to remove tumors of the distal segment of the femur and resection of the tumor of the diaphysis of the femur, in all cases, the radicality was R0.Conclusion. Individual navigation devices have proven themselves in clinical practice. The results obtained in our study demonstrate their effectiveness in the treatment of malignant bone tumors.

Chordomas of the sacrococcygeal region account for more than 50 % of all sacral tumors. These malignant neoplasms grow slowly and are asymptomatic for a long time. As a result, chordomas often reach large sizes and affect the neurovascular structures of the sacrum and pelvic organs. The use ofen-bloc resection allows to increase survival rates and reduce the risk of progression. However, this method of chord treatment is difficult for surgeons and in most cases, after surgery, the quality of life of patients decreases. The improvement of imaging methods, the success of oncological orthopedics and radiation therapy allow performing radical organ-preserving operations. In this article, we will consider the modern concept of treatment with a sacrococcygeal chord.

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.

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.

The main method of treating rare mesenchymal tumors PEComas is surgical removal of the tumor and external-beam radiation therapy has historically been considered ineffective. However, the individual cases in the foreign literature as well as this article authors’ experience in the form of the clinical case provided in it shows the possibility of achieving some anti-tumor effect due to the use of aggressive variants of radiation therapy. The use of variations of stereotactic radiotherapy with high dose per fraction and sum dose as an neoadjuvant and definitive treatment looks promising.

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.