A. V. Bogoutdinova

Bladder cancer occupies a significant place among all malignancies, accounting for approximately 3 % of all new cases of malignancy per year, with approximately 37 % of all bladder cancer cases being fatal (about 213,000 deaths annually). Despite advances in diagnosis and treatment, patients with muscle-invasive cancer remain at high risk for recurrence and metastases, especially delayed metastases that may occur years after completion of primary treatment. These delayed metastatic manifestations are often associated with poor prognosis and treatment difficulties. This article presents a clinical case of late progression of bladder cancer to the left pubic bone without regional metastases 12 years after combination treatment.

Introduction. Giant cell tumor (GCT) of bone is a relatively rare neoplasm. Its malignant transformation in the form of sarcomatous changes occurs in 8–10 % of cases. The literature lacks data on radiological signs and differential diagnostic criteria of primary malignant GCT of bone. Clear guidelines on the density range of the affected area for differential diagnosis are also absent. Aim. To analyze dynamics of tumor density changes in patients with malignant GCT of bone using computed tomography densitometry. Materials and methods. Ten patients (mean age 45.8 ± 4.2 years, range 28–58 years) with malignant GCT of bone were examined. All underwent treatment with denosumab with subsequent surgical intervention. Bone changes were assessed visually. Densitometric analysis was performed in accordance with a method developed by us involving determination of tumor density in Housefield units (HU) and relative tumor density index (k) (ratio between tumor density and density of the unaffected limb at the same level). Results. After 6 injections of denosumab, a clear sclerotic rim appeared at the tumor periphery containing thin lines of ossification. Analysis of densitometric parameters showed that tumor density after denosumab administration increased from 46.3 (median (Мe) 35.0; interquartile range (IQR) 51.4) HU to 88.8 (Мe 84.8; IQR 118.4) HU, while relative tumor density index increased from 0.33 (Me 0.22; IQR 0.45) to 0.68 (Me 0.62; IQR 0.89). Earlier we have published threshold values of these parameters (≥139.5 HU and ≥0.97, respectively) at which probability of residual tumor is lowered (sensitivity 81.8 %, specificity 96.6 %). Taking into account these values, 9 of 10 patients required continuation of therapy. Conclusion. Computed tomography densitometry allows to evaluate changes caused by denosumab therapy in patients with malignant GCT of bone. According to radiological data, progression of this disease has unique features. Taking into account histological types of malignant GCT, longer periods of observation and denosumab administration or changes in treatment tactics at the preoperative stage can be considered, as well as potential use of this drug in other primary bone tumors.

Introduction. Difficult diagnosis, aggressive progression, and absence of an increase in treatment effectiveness (especially in patients with osteosarcoma and Ewing sarcoma) make malignant tumors of the bones a significant medical problem. Use of traditional therapy methods is often associated with development of drug resistance and frequent recurrences. Therefore, there is a need for new treatment strategies and overcoming of the limitations of traditional methods through their improvement, combination or substitution to achieve higher survival, lower recurrence rate, and wider availability for patients with bone tumors.Aim. To present a clinical observation of the use of a new method of radical intraoperative thermal ablation for bone tumors, assess exposure tolerance, long-term oncological and functional results.Clinical observation. This article presents a clinical case of the use of a new radical treatment method for a patient with tibial osteosarcoma who underwent intraoperative thermal ablation using a new domestic complex of local hyperthermia “Phoenix-2”.Results. A session of intraoperative thermal ablation was performed in the operating room under anesthesia directly in the wound for 48 minutes. Access to the tumor-affected bone was performed with the standard oncological approach (en-block), the bone was not transected or removed. A constant heating mode of 90 °С was used, assuming a gradual increase in temperature. Thus, 60 °С reached 20 minutes, and the temperature at the end of high-temperature exposure was 78 °С (inside the medullary canal). The operation time was 2 hours 30 minutes. The postoperative period proceeded without complications. After 38 months of follow-up, examinations did not reveal any recurrence or progression in the patient.Conclusion. The technique of radical intraoperative thermal ablation using a local hyperthermia complex Phoenix-2 is effective and allows to widen the toolkit of treatment methods for patients with bone tumors. It can serve as an alternative or addition to organ-preserving surgical treatment without costly reconstruction stages.

Introduction. An additional or the only way to treat tumors of the chest wall is often a surgical method, which inevitably results in a post-resection defect. Reconstruction of extensive chest wall defects remains an unsolved problem for surgeons around the world.The study objective – to present the long-term oncological and functional results of treatment of a patient with multiple locally recurrent leiomyosarcoma after reconstruction of an extensive post-resection chest wall defect using superelastic 3D frame modules made of titanium nickelide. Reconstruction of the chest wall with 3D modules after extensive block resection showed the possibility of not only restoring the anatomy in the area of the post-resection defect, but also maintaining the biomechanics of breathing in the postoperative period.Clinical observation. This study presents a clinical case of extensive resection and successful one-stage reconstruction of the chest wall skeleton with 3D superelastic titanium nickelide modules in a patient with recurrent leiomyoma with locally recurrent leiomyosarcoma.Results. The superelastic modules did not limit the width of the resection during the operation and ensured long-term stability of the position of the reinforcing elements of the artificial framework. Control examinations showed no tumor recurrence after 12 months and maintaining patient performance.Conclusion. The effectiveness of the proposed reconstruction expands the possibilities of treating patients with tumors of the chest wall.

The study objective is to evaluate the effectiveness of preoperative targeted therapy, spectrum and rate of adverse events, as well as quality of life in patients with bone metastases of renal cell carcinoma.Materials and methods. The study was conducted at the Research Institute of Oncology, Tomsk Medical Research Center between 2014 and 2018. The study included 34 patients with bone metastases of renal cell carcinoma who received preoperative targeted therapy with pazopanib for 8 weeks. All patients underwent surgical treatment of both the primary tumor and bone metastases.Results and conclusion. It was shown that preoperative targeted therapy is characterized by a high rate of clinical response and satisfactory tolerability. In some cases, preoperative targeted therapy improves the conditions for surgical treatment of metastatic bone lesions, decreases intraoperative blood loss, decreases the volume and duration of surgical intervention, which, in turn, allows to preserve bigger range of motion in the affected bone segment and improve patients’ quality of life.