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Soft tissue sarcomas (STS) are rare and heterogeneous group of mesenchymal cell tumors, accounting for only 1% of all malignances. Every year about 3700 new cases of STS are registered in Russia, while the annual increase rate was 6.45% in 2019. Randomized studies confirm the feasibility of combination therapy for STS. The review contains a comprehensive description of the proposed methods of combined treatment of STS. Advantages, disadvantages, directions and features of various methods of radiation therapy for STS are shown on the examples of scientific research of recent years.

Preoperative radiotherapy in patients with soft tissue sarcomas characterized by important advantages: high precision of dose delivery, reduction of tumour volume and implantation potential, induction of immunologic response. Postoperative radiotherapy associated with decreased complication rate, delivery of treatment to microscopic disease according to pathologic report. Combination of pre- and postoperative irradiation gives the opportunity to use best of both methods. The aim: analyses of feasibility and safety of radiotherapy protocol that combined pre- and postoperative radiotherapy in patients with soft tissues sarcomas of extremities. Materials and methods: from 06.2018 to 01.2020 ten patients with soft tissue sarcomas of extremities were included in the protocol. Preoperative stereotactic ablative body radiotherapy (SABR) was performed as 5 fraction of 7 Gy on the main tumor volume with dose reduction to 5Gy in 5 fraction on the margins of the field. Postoperative radiotherapy started 5-8 weeks after surgery and was performed as standard compartmental irradiation in 25 fractions of 2Gy. Complications were determined according to CTCAE and wound complication scales. Results: from 06.2018 to 01.2020 10 patients with soft tissue sarcomas of extremities were included in the study. Pre-opeartive SABR and subsequent radical resection with tumor free surgical margins were performed in all 10 cases. Primary wound closure was mentioned in all patients. With relatively short follow-up of 9.1 (3-20) months we didn’t mentioned any case of grade II or more toxicity and no local recurrences. Conclusion: Our preliminary results demonstrate that combination of preoperative SABR and postoperative conventional radiotherapy is feasible and associated with low probability of grade II (and higher) toxicity.

Purpose: the aim of the study is to assess the effectiveness and safety of prostate cancer treatment (PCa) with high dose rate brachytherapy (BT-HDR) in monotherapy on 5 years of follow-up. Materials and methods: BT-HDR is performed in 198 patients of PCa. The fractionation schedule was presented by two options: two fractionations of 13 Gy in the first group (67 people) and three fractionations of 11.5 Gy in the second (131 patients). The treatment was carried out with 192Ir (Microselectron). Results: the median for patient care was: I group - 59.2 (41.4-90.3), II - 56.1 (39.4-86.4) months. During the follow-up, no patients died from the progression of the PCa. The three-year survival rate without biochemical progression was 98.5%, while the second group had 92.8%; 88.8% and 88.1%, respectively. There were no significant differences in survival rates between the BT-HDR fractionation regimes compared. In most cases, late genito-urinary radiation toxicity was represented by changes that could be characterized as 1st degree. A total of 161 patients with a three-year follow-up period had three cases (1.8%) radiation-induced stenosis urethra (complications of 3 degrees): two of them in the first group, one in the second group. Only one patient (I group) (1.5%) recorded late recto-intestinal toxicity of the 2nd degree. There were no third or higher violations in the observed groups. Conclusions: the studied mono-modes of fractionation of BT- HDR PCa (two factions of 13 Gy and three factions of 11.5 Gy) demonstrated quite acceptable indicators of effectiveness and safety with a five-year period of observation. It has been established that there are no significant differences in the frequency of biochemical relapses, as well as the severity of early and late radiation toxicity in the groups compared.

The purpose of the study was to analyze treatment outcomes in prostate cancer patients, who received external radiotherapy combined with high dose rate (HDR) 198 Ir brachytherapy boost of 10 Gy in 2 fractions or 15 Gy in 1 fraction. Material and methods. Between July 2012 and June 2017, 98 patients with prostate cancer received radiation therapy at N.N. Petrov National Medical Research Center of Oncology (St-Petersburg, Russia). Intensitymodulated radiation therapy (IMRT) at a total dose of 46–50 Gy was delivered to the prostate, seminal vesicles and regional lymph outflow areas (RTOG, 2009). The patients were then divided into 2 groups. Group I patients (81 patients, 82.7 %) received HDR brachytherpy boost of 10 Gy in 2 fractions, Group II patients (17 patients, 17.3 %) received HDR brachytherpy boost of 15 Gy in 1 fraction. Inclusion criteria were: high or extremely high risk of relapse according to NCCN (2010), no evidence of distant metastases and no evidence of pronounced urinary tract disorders (residual urine volume less than 50 ml, IPSS less than 17 points, maximum urination rate ≥10 ml / sec). Assessment of radiation-induced complications (toxicity) was carried out in accordance with generally accepted RTOG / EORTC (1995) criteria and taking into account the terminological recommendations of CTCAE v 4.0 (2009). Results. The median follow-up time was 39.2 [30.7; 48.7] (20.3–69.8) months in Group I and 37.0 [30.9; 47.9] (23.7–50.7) months in Group II. The 3-year disease-free survival rate in the study groups regardless of the boost was 77.1 % (75.9 % in Group I and 77.8 % in group II, p=0.7). The 3-year disease-free survival rates in patients with high and extremely high risk regardless of the radiotherapy regimen were 88.6 % and 70.8 %, respectively (р=0.04). Genitourinary early radiation toxicity and rectal intestinal early radiation toxicity of grade 3 were observed in 13.5% and 12.3 % of Group I patients and in 17.6 and 5.9 % of Group II patients. The most significant late complications were the formation of urethral stricture (1 patient of group I) and postradiation rectal stenosis (1 patient of group II). Evaluation of the level of erectile function in both groups showed a significant decrease in satisfaction with the quality of sexual life, which, apparently, can be explained not only by radiation damage to the structures responsible for hemodynamics of the penis, but also by castration syndrome due to prolonged hormonal deprivation in the vast majority of patients. Conclusion . The combination of external beam radiation therapy with HDR brachytherapy boost is an effective method of radical treatment of prostate cancer patients with high and extremely high risk of recurrence.

The review article discusses the possibilities of using high-intensity focused ultrasound (HIFU) in oncology. The technical principles and features of HIFU ablation, a brief history of the development of HIFU therapy, the principles of HIFU therapy, the physical basis of the HIFU ablation method, and the mechanisms of antitumor action of HIFU therapy are presented. The results and benefits of HIFU therapy for various malignant and benign tumors are discussed.

Melanoma is on the first place in mortality among all skin tumors. Over the past 50 years, there has been a steady increase in the incidence of cutaneous melanoma compared to other types of tumors. Rates of 5-year survival are fairly high, if melanoma is diagnosed in the early stages, which requires adequate diagnostics and treatment. Melanoma diagnostic, especially in the early stages, can be problematic even for an experienced dermatologist. However, primary contact doctor can be any specialty. Melanoma and other skin tumors can be detected by physical examination during treatment for another disease. Phenotypic risks factors, anamnestic data, and physical examination data are important in cutaneous melanoma diagnostics. The sensitivity of clinical diagnosis during a visual examination by an experienced dermatologist is approximately 70 percent. However, dermascopy can significantly increase the accuracy of a clinical diagnostics. In recent years there has been an active research for new non-invasive methods and algorithms for cutaneous melanoma diagnostics. The main goal of non-invasive diagnostics is to determine need for biopsy. This decision should be based on a combination of clinical and dermascopic examinations and other information, including growth dynamics, symptoms and medical history. Thus, an adequate diagnostic of cutaneous melanoma, including non-invasive and invasive methods, is a simple and economically viable way to early detection of cutaneous melanoma and to reduce mortality from this aggressive disease.

In tumor microenvironment the self-maintenance condition of T-regulatory lymphocytes (Treg) are created by tumor cells due to the production of vascular endothelial growth factor VEGF and chemokine CCL2. In the present work there was evaluated the quantitative content of these proteins in cultured cell supernatants of metastatic soft tissue sarcomas (STS) as well as characterized the immunophenotype of peripheral blood Treg by flow cytometry. The study included 35 patients who received treatment at the N.N. Petrov National Medical Research Center of Oncology. For the study- samples of metastatic tumor were taken to obtain sarcoma cell culture and samples of peripheral blood of patients in the absence of tumor growth (stable disease-SD) or disease progression (PD). The statistically significant differences were found in the quantitative content of CCR10+Treg (9.1 % and 4.5 %, respectively, p=0.001), CCR4+Treg (10 % and 3.3 %, respectively, p=0.001), neuropilin-1 (Nrp1+) Treg (6 % and 4.5 %, respectively, p=0.021) in patients with PD and SD. A direct correlation of high strength was found between production of VEGF, CCL2 by metastatic STS cells and expression of Nrp1 (r=0.93, p=0.001), VEGFR-2(r=0.88, p=0.007), CCR4(r=0.81, p=0.024) by Treg cells. Statistically significant differences in the CCR10+Treg (9.5 % and 2.93 %, respectively, p=0.012) and CCR4+Treg (68, 3 % and 3.95 %, respectively, p=0.007) were detected in the group of patients with liposarcoma and synovial sarcoma. Thus in patients with metastatic STS - there was directional chemotaxis of Treg into tumor microenvironment providing the creation of tumor-induced tolerance, which could be associated with DP. The revealed regularities could be used to plan adjuvant and palliative treatment of STS patients.

Background: The most striking clinical feature of soft tissues sarcomas (STS) is their ability to recur. At present disputes about the clinical and morphological factors of STS recurrence such as the degree of malignancy, size, location, depth of tumor location, patient’s age and the presence of previous relapses in the anamnesis do not subside. It also requires clarification of the effect of the volume of tissues removed on the long-term results of treatment of STS as well as indications for the application of various regimes of remote radiation therapy. Materials and methods: Of 1802 registered cases of STS of extremities at the N.N. Petrov National Medical Research Center of Oncology from 2004 to 2016 there were selected data on 213 patients who suffered from at least one relapse of the disease. There was performed an assessment of overall, non-metastatic and disease-free survival using a single-factor (the Kaplan-Meier method) and multivariate analysis (the Cox regression model). Conclusion: The detection of various prognostic factors of locally recurrent STS allows determining the necessary treatment tactics (the vastness and traumatism of surgery and the advisability of radiation therapy).

The purpose of the study was to systematize the data available in the modern literature on the diagnosis and treatment of metastatic melanoma without clinically evident primary tumor. Materials and methods. The results of laboratory-instrumental diagnostics, surgical and drug treatment presented in randomized clinical trials, published over the past 10 years in Medline, Embase and the Cochrane Library were analyzed. Results. Despite continuous improvement in imaging techniques, melanoma accounts for up to 12.6 % of all cases of metastatic cancer with an unknown primary site. Metastatic melanoma without clinical evidence of primary tumor accounts for approximately 1% to 8% of all melanoma cases. Conclusion. Metastatic melanoma without clinically evident primary tumor has not been extensively studied. Until now, only a few reports on metastatic melanoma without clinically evident primary tumor have been available. Therefore, further prospective studies of clinical course and optimization of diagnosis and treatment of patients with metastatic melanoma without clinically evident primary tumor are needed.

For the first time comparative study of open and closed techniques of hyperthermic intraperitoneal chemoperfusion (HIPEC) in terms of safety and efficacy was performed in a rat model of ascetic ovarian cancer transplanted intraperitoneally. Original device and implantation technique of the device into peritoneal cavity were developed and used in the study. All animals after tumor implantation were randomized into 4 groups: 1 - control, intraperitoneal administration of 0.5 ml of saline (n=19); 2 - closed HIPEC with cisplatin, 20 mg/ kg (n=15); 3 - open HIPEC with cisplatin, 16 mg/kg (n=16); 4 - open HIPEC with mitomycin C (n=10). In preliminary stage while working out the original open technique of HIPEC we established that it requires dose reduction for cisplatin from 20 to 16 mg/kg compared to closed technique of HIPEC. We didn't find significant difference between groups 1, 2 and 3 in terms of number of postoperative complications. According to the results of analysis of body weight changes in postoperative period open HIPEC was worse tolerated compared to close HIPEC. Median survival of rats in group 2 was 53 days which was significantly higher compared to median survival in group 2-25 days (p=0,044). Open HIPEC with mitomycin C turned out to be less effective than open HIPEC with cis-platin but equally effective compared to closed HIPEC with cisplatin. However this is preliminary result and more rats have to be included in group 4 in order to make confident conclusion. Overall open HIPEC with cisplatin in accordance with suggested technique seem to be more promising than closed HIPEC in terms of improving outcomes of patients with peritoneal carcinomatosis.

At the N.N. Petrov Research Institute of Oncology from 1986 to 2015 there were performed 445 radical operations for skin melanoma of upper and lower extremities in patients aged 18 to 87 years. The present study analyzed data of 40 patients with morphologically confirmed diagnosis of “subungual melanoma” (SM). Long-term results and causes of death were evaluated in all operated patients. A 1-year survival rate of SM patients, whatever stage of disease was 90%, a 5-year overall survival rate - 47%, while only 20% of patients have survived a 10-year line. Overall survival median was 55 ± 9.4 months (95% CI, 36.4-73.5). The probability of death of radically operated SM patients in the next 5 years after surgical treatment from co-morbidities did not exceed 10%. SM patients had the worst prognosis as compared with patients with skin melanoma of upper and lower limbs (p = 0,0001).

This study presents an analysis of the effectiveness of organ-preserving surgeries using various endoprostheses in patients with malignant tumors of the pelvic bones. Nine patients (male - 3, female - 7) with malignant tumors of the pelvic bones (chondrosarcoma - 7, osteosarcoma - 1, me-tastases - 2) underwent organ-preserving surgeries with endo-prosthetics of the postresection defect. The average age of the patients was 38 years (15-67 years). During the operation two patients were equipped with individual prostheses of Waldemar Link, one patient - a combined prosthesis with an individual pelvic component (from Biomedical) and a modular femoral component. In 7 patients modular structures of Implant-Сast were used. The pelvic component was cementless, femoral -more often (7 cases) on a cement basis. Patients were assessed by oncological, surgical and functional results. Anatomically-functional status was assessed on the MSTS scale. As a conclusion good functional and oncological results can be obtained even with the resection of three segments of the pelvic bones if the ileal bone volume is sufficient for a good fixation of the endoprosthesis. To achieve the most durable fixation of the femoral component of the endoprosthesis it is better to use bone cement.