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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 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. 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.

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.

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 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.