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The results of these studies coincided with domestic and foreign literature. X-ray, CT and MRI findings were compared with postoperative assessment histological data. Usefulness of x-ray, CT and MRI studies amounted to respectively 57,1±6,5%, 85,0±3,7% and 75,1±5,1%. This, in turn, shows the great role of CT in diagnosis of benign bone tumours and tumour-like formations.

Surgery for pathological fracture of long tubular bones associated with metastatic cancer was given to 77 patients (1993-2000): segmental resection with endoprosthetic replacement - 26; intramedullary osteosynthesis - 17; perosseous extrafocal osteosynthesis - 34. No intraoperative complication was reported. Infection-related postoperative complications, mainly in perosseous osteosynthesis, developed in 5 (7%). All patients were self-sufficient on days 3-10 after operation.

Seventy patients operated on for malignant tumors located in the extremities have been examined, 30 of them were operated on under conduction anesthesia. The adequacy of anesthesia was assessed using clinical metabolic and electrophysiological techniques. Evident advantages of conduction anesthesia over general anesthesia during short-term interventions have been substantiated. Anesthesia with bupivacaine proved most effective.

Levels of prostaglandin E (PGE), prostaglandin F2 alpha, prostacyclin A2, thromboxan B2 and leucotriene B4 assayed radioimmunologically were compared in 42 samples of osteogenic sarcoma and 22 samples of benign tumors and tumor-like lesions from children at the pubertal period. In osteogenic sarcoma samples, PGE and prostaglandin F2 alpha levels were higher than those of thromboxan B2, prostacyclin A2 and leucotriene B4. Osteogenic sarcoma revealed higher levels of the eicosanoids as compared to benign tumors and tumor-like lesions of the bone. An inverse correlation was established between PGE level and time of dissemination of osteogenic sarcoma. The role of eicosanoids in the pathogenesis of growth and dissemination of osteogenic sarcoma is discussed. The use of non-steroid anti-inflammatory drugs in complex treatment of osteogenic sarcoma of children at the pubertal period is suggested.

The paper deals with a comparison of basal levels of secretion of total testosterone (T) and estradiol-17 beta (E2), their free and albumin and sex-steroid-binding globulin fractions as well as LH, FSH, prolactin and STH in blood serum of 60 normal height and 60 tall healthy adolescents and those with primary osteogenic sarcoma of bones at different stages of puberty. The study established a significantly higher level of testosterone and free androgen index and a lowered concentration of sex-steroid-binding globulin in blood serum of both normal and tall adolescent patients with osteogenic sarcoma at different stages of puberty. No significant differences were found in said indexes of estrogens between sarcoma patients and a specific group chosen for comparison, as far as physical status is concerned. The role of sex steroid hormones and, particularly, that of androgens in the pathogenetical mechanisms of osteogenic sarcoma growth is discussed.

Three hundred and ninety-three patients with IIB osteosarcoma were treated at the author's institution between 1955 and 1986. In the first stage of the study, 88 patients were treated with surgery only. The five-year disease-free survival rate was 7%. In the second stage of the study, the efficacy of preventive chemotherapy after radical surgery was studied in 55 patients. The five-year disease-free survival rate was 34.4%. In the third stage of the study, the efficacy of combination therapy consisting of preoperative treatment, limb-saving surgery, and preventive chemotherapy was studied in 66 patients. The five-year disease-free survival rate was 35.5%. The authors examined results in 21 patients with Grade IV responses to evaluate the relationship between prognosis and morphogenic changes after preoperative radiotherapy and chemotherapy. The five-year disease-free survival rate was 57.9%. In the fourth stage of the study (conducted in 1986), two regimens of preoperative chemotherapy were initiated. The first regimen consists of intraarterial platinum infusions to patients with lower extremity bone damage. The second regimen consists of high-dose methotrexate infusions. The preliminary conclusion is that primary tumor damage is significantly more marked after intraarterial cisplatin infusion.

A relationship between blood plasma levels of polypeptide growth factors and those of peptide and sex steroid hormones, as assayed radioimmunologically, was studied in 91 patients with bone tumors of various histology and 45 healthy donors. The levels of insulin-like growth factor (IGF-1) and somatotropic hormone were significantly higher in cases of chondrosarcoma and patients suffering osteogenic sarcoma in the late puberal period as compared to controls and cases of fibrous histiocytoma, giant-cell tumor, benign tumors and tumor-like lesions of the bone. The peak levels of IGF-1, somatotropic hormone and insulin were registered in osteogenic sarcoma patients who developed pulmonary metastases either in the course or after the completion of combined treatment. Somatostatin level was significantly lower in patients with osteogenic sarcoma aged 11-20 years as compared to healthy adolescents, the lowest level being observed in adolescents suffering osteogenic sarcoma with metastases to the lungs. No relationship was established between total testosterone level, on the one hand, and those of IGF-1 and epidermal growth factor, on the other. A reverse correlation was established between concentrations of IGF-1 and total estradiol. The role of polypeptide growth factor antagonists in combined treatment of bone sarcomas is discussed.

Principles of evaluating prognosis in parosteal sarcoma were developed with respect to clinical and morphological pattern of disease and type of treatment. A mathematical model for making prognosis and a procedure for its multifactorial analysis were suggested.

The results of treatment of 315 cases of osteogenic sarcoma are presented. Available methods of primary tumor therapy fail to prevent dissemination of neoplastic disease by blood circulation. However, following a prophylactic course of chemotherapy (adriamycin, vincristine, cyclophosphamide, sarcolysine), 3- and 5-year survival rates in 45 cases of limb amputation for osteosarcoma increased to 38.1% and 30.5%, respectively. No recurrences were observed in 39 patients with extensive segmental resection of bone who preoperatively received intra-arterial infusions and radiation therapy; the 3-year survival rates were a high as 43.9% and patients showed good performance. The method offers good advantages in the treatment of patients with osteogenic sarcoma.

The paper is concerned with definite trends in rehabilitation following such kind of operations as amputation of the lower extremities, exarticulation in the coxa, interiliac-abdominal exarticulation and interscapular-thoracic amputation for malignant tumors. The method of prosthetic replacement on the operating table after amputation of the lower extremities and early application of medico-physical therapy after exarticulation and interiliac-abdominal exarticulation shortens the time of stump formation, thus enabling patients to resume their socio-labour activities in early terms after the operation.

The experience in the management of 246 patients with local osteogenic sarcoma and 67 patients with pulmonary metastases in the All-Union Oncologic Research Center, AMS USSR, is presented here. All the patients underwent surgery, but starting in 1974, various modalities of adjuvant chemotherapy (not randomized) were applied in addition. In the surgery alone group, prognosis was very poor: only 7.0% of patients survived free of disease 5 years from the primary tumor treatment. Adjuvant chemotherapy (adriamycin + vincristine + melphalan + cyclophosphamide) following amputations increased this rate to 34.0%; combining segmental resections of an affected bone with preoperative intraarterial adriamycin infusion and radiation (36 Gy) increased the rate to 35.5%. In patients with grade 4 tumor damage (tumor cells are not found upon examination of a large number of sections), the rate increased to 57.9% (P less than .05). Another regimen of adjuvant chemotherapy (platidiam or cisplatin + adriamycin + cyclophosphamide) gives a chance to 78.8% of patients to survive 1 year free of metastases. The same chemotherapy regimen enables us to achieve an objective effect in 30.8% of patients with pulmonary metastases, and its combination with surgical metastasis ablation makes it possible to obtain a complete remission, lasting from 2 to 46 months (average 13.9 months). Toxic manifestations of the chemotherapy regimens considered are moderate. Prognosis in adjuvant chemotherapy is related to age, tumor site, its local dissemination, and morphologic type of osteogenic sarcoma.

The results of combination therapy of 510 patients with osteosarcoma were analysed. It was established that most advantage is offered by this therapy in cases of osteogenic sarcoma and Ewing's sarcoma supplemented with surgery whenever required. A 33.9 and 30.1% increases in 3- and 6-year survival, respectively, were registered in 50 cases of osteogenic sarcoma, following amputation and a course of polychemotherapy (adriamycin, vincristin, sarcolysin and cyclophosphamide). There were no relapses in 40 cases of extensive segmental resection of the site of bone lesion with preoperative intra-arterial infusion of adriamycin, radiation therapy and adjuvant polychemotherapy. This scheme resulted in 4-year survival in 55.7% and good performance. A 5-year survival rose to 40.8% in 45 cases of Ewing's sarcoma, following adjuvant therapy with sarcolysin or cyclophosphamide administered after a course of radiation therapy in the dose of 50-60 Gy.

Endoprostheses of the knee (14) and hip (after Sivash ) (2) joints were used in the treatment of 16 children operated on for osteogenic sarcoma at the Center Clinic. Postoperative complications leading to amputation occurred in two cases of lesions of the proximal part of shinbone . Good functional results were obtained: knee joints supplied with endoprosthesis flexed through 80 degrees. The results are only preliminary considering the relatively short period of the study but they are encouraging enough.

The effect of adjuvant chemotherapy on survival and prognosis in osteogenic sarcoma versus basic clinico-roentgenomorphological characteristics of tumor was studied in 108 cases. Prognosis was found to depend on patient's age, site and size of tumor, but mainly on the roentgeno-morphological pattern of the latter. Osteolytic form appeared to have a better course in cases of adjuvant chemotherapy. This was matched by osteoplastic form requiring surgical treatment only. The results suggest a strictly differentiated approach to selection of treatment modality, particularly in cases of post-operative chemotherapy.

The frequency of subsequent tumor development in patients suffering from acquired ichthyosis and Darier's erythema as well as cases of concurrent dermatosis and malignant diseases was studied. The clinical course of said skin diseases was followed versus the effectiveness of tumor treatment. Acquired ichthyosis was found to be associated predominantly with neoplasms while the incidence of Darier's erythema was not. As a result, cases of acquired ichthyosis should be considered at high risk for cancer for life while patients with Darier's erythema aged more than 40 years should not be necessarily tested for tumors unless they have suffered dermatosis for at least three years.

The authors analyzed immediate, short-term results of thermoradiotherapy of 112 patients and radiotherapy alone of 91 patients (control group). All had tumors of different sites. Local hyperthermia used as an adjuvant to radiotherapy made it possible to increase the frequency of complete tumor regression from 0 to 11% in rectal cancer patients, from 86 to 100% in head and neck cancer patients, from 0 to 14% in the patients with soft tissue sarcomas and from 40 to 71% in children with rhabdomyosarcomas. These results suggest a possibility of raising the efficacy of radiotherapy combined with local electromagnetic hyperthermia.