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An analysis of results of treatment and prostheses of 89 patients with malignant tumors of the upper extremities and shoulder girdle has shown that among the tumors there were osteogenous sarcomas, chondroid sarcomas, nonclassified sarcomas, reticulosarcomas, angiosarcoma, fibrohistocytic sarcoma, Euring's sarcoma, solitary myeloma, giant cells tumors. Interscapular-thoracic amputations were performed in all the patients. The overall survival rate was (28.6 +/- 8.3)%. An orthosis and a modified prosthesis developed at the research institute of prostheses named after prof. G. Albrekht are recommended for rehabilitation of invalids.

The study group included 104 patients with soft-tissue sarcoma and metastases into the lung, treated at the Institute Clinic in 1960-1992. Surgery for lung metastasis was given to 10 and chemotherapy-to 48 patients; the remaining 48 cases received treatment for symptoms only. Overall 5-year survival was 13.5% (after surgery-30.0%; chemotherapy-19.1%). All the 46 patients treated for symptoms died within two years after detection of lung metastasis. Chemotherapy proved effective in the treatment of multiple metastasis when detected shortly after removal of the first lesion.

On the basis of the data on 650 cases of soft-tissue sarcoma, improvements to surgical treatment of these tumors have been made versus localization, local extension and histological pattern. Optimal size of area to be excized has been determined. Procedures for organ-saving surgery involving resection of nerves, vessels and underlying bones, in cases of locally-extended tumors, have been evolved. Optimal procedures for skin reconstruction have been suggested. The rationale has been given for indications to amputation. The 5-year survival in patients with soft-tissue sarcoma was 52,6%, while local recurrence incidence-23%.

According to data of the Research Institute of Oncology named after N. N. Petrov, progress was achieved in treatment of patients who were subject to interilioabdominal amputation for malignant tumors. Five years survival after such operations was 19.7 +/- 3.4%. The prosthesis for patients subjected to interilioabdominal amputations was developed in Research Institute of Prosthesis (Saint Petersburg). It was successfully used in 11 patients in the age from 8 to 51 years. The original construction of the prosthesis gives the patients possibility to walk without crutches, move along staircases with 25-cm-high footsteps and to use urban transport.

Data of examinations of 1176 patients with different diseases of soft tissues have shown that the arsenal of diagnostic methods which can be used under laboratory conditions has become wider. Of special value is the method of aspiration biopsy which must be introduced into medical practice. In obscure and doubtful cases the examination must be complex, including soft-tissue roentgenography, echography, thermography and radionuclide examination. Angioscintigraphy of soft tissues is an important method in differential diagnostics when the tumor is localized on extremities. Fairly promising is the method of magnetic resonance computed tomography.

Data of 13 patients with tumors of the locomotor system subjected to +interscapular-thoracic resection (ITR) are presented. Main technical aspects of ITR are described. Complications took place in 6 patients, including marginal necrosis of the skin in 4 patients. As a whole the 5-year survival made up 49.9% +/- 13.8%. Data are presented on rehabilitation measures which allow to widen the functional possibilities of the extremity.

Data on 145 cases of soft-tissue tumor of the trunk were analysed. Tumor was located on the chest or back in 81 patients and deep in the anterior abdominal wall--in 64. When intramuscular sarcoma is removed, a 2-3-cm margin should be left around the palpable mass. Five-year survival in the entire group of patients with tumors of the chest and back was 59.4% +/- 2.4. Five out of ten cases with tumor of the abdominal wall survived over 5 years.

The analysis of data on 446 patients with soft tissue malignancies showed overall five-year survival rate to be 48.9%. The extent of tissue to be removed during sparing surgery is specified. In case of intramuscular location of tumor, it is enough to leave a 4-5-cm margin above and below the tumor border, as assessed by palpation. Indications for limb amputation at various levels were developed. Limb-sparing surgery could be employed on a larger scale if advances of modern plastic (skin, bone and vascular) surgery were adopted wider. A complex of rehabilitative measures was developed. Patients undergoing limb amputation need early prosthetics.

Data on 544 patients with esophageal cancer are reported. The main reasons of their refusing the radical treatment were as follows: 1) a considerable local tumor proliferation (31.8%); 2) senile age, concomitant diseases, a general poor condition of patients (25.6%); 3) the presence of distant metastases (11.4%); 4) location of a tumor in the jugular or upper thoracic esophagus for which palliative radiotherapy was performed, but in some cases a palliative surgery (9.7%); 5) fear of surgery (15.4%); 6) no reason (6.4%).

According to the authors' data the total 5 years' survival among 444 cases, subjected to radical operations for malignant tumors of the soft tissues, constituted 51.6% and proved to be practically the same both in primary and recurrent tumors. The improvement of the 5 years' results of the combined treatment (surgery and radiotherapy) of soft tissue sarcoma was noted, even when taking into account the stage of the disease and cellular differentiation of the tumor.

Pigmentary villonodular synovitis was isolated in an independent nosological unit in 1941. A comparative analysis of data on 278 patients with soft tissue sarcomas of lower extremities (262 observations) and pigmentary villonodular synovitis (16 observations) is presented. Clinico-historical data, results of instrumental methods of examination evidence the absence of any definite symptoms of these diseases. Findings of punctures are most informative.

The results of radioisotope scanning in 70 patients with tumors and nontumor lesions of soft tissues of the extremities are presented. It was found that angioscanning with macroalbumin-iodine-131 (MAA-J-131) allows visualization of malignant tumors of soft tissues.

An analysis of data of 348 patients with malignant tumors of soft tissues has shown that 128 of them had been subjected to the amputation of extremities at different levels. The use of microsurgical techniques favours the improvement of the method of amputation of lower extremities, in particular the transplantation of a calcaneoplantar flap onto the stump end. In order to make the treatment of phantom limb pains more effective acupuncture should be included into the complex of therapeutic measures in addition to traditional methods. Close contacts with prostheses-makers can facilitate earlier prosthesis which can give positive effects on the following rehabilitation of such patients.

The interilio-abdominal amputation was fulfilled in 62 patients for the period from 1960 to 1979. The postoperative mortality was 6,4%. General five-year survival was 24,3% +/- 5,6. The survival terms were dependent first of all on the tumor type. The advances of anesthesiology, reanimatology and operative oncology have considerably reduced the danger of interilio-abdominal amputation. So, indications for the operation can become wider even in the cases when it has a palliative character.

In 1015 patients with various diseases of soft tissues the pathological process was localized in the anterior abdominal wall in 64 patients (6,3%): desmoids were found in 41 patients, sarcomas -- in 12, benign tumors -- in 5 and non-tumor diseases -- in 6 patients. Dissection of the tumor must be performed not less than 2 -- 3 cm further than the pulpated borders. When plasty with local tissues is not possible, it is expedient to employ synthetic (terylene) prostheses.

The examination performed indicated metastases in regional lymph nodes in 34 (7.5%) of 453 patients with soft tissue malignancies. The presence of metastases aggravates considerably the prognosis: a 5-year survival was 6.6%. Great risk of metastatic proliferation is especially characteristic of rhabdomyosarcoma, non-classifiable blastoma and synovial sarcoma. Primary tumors develop metastases more frequently than recurrent ones. The probability of lymphogenic spread of metastases is the higher the larger the tumor size in young individuals, and also with skin involvement. Tumor infiltration of bones does not result in an increased percentage of lymphogenic metastasization. The proximity of a tumor to regional lymph nodes is not inherent in a higher risk of their metastatic involvement.

From the authors' data adenogenic cancer of the esophagus was found in 11 out of 90 patients who were subjected to intrathoracic extirpation of the esophagus in Dobromyslov-Torek method. The macroscopic pattern of glandular cancers of the esophagus characterized by a diffuse-infiltrative growth with the involvement of all the layers of the wall and ulceration of the mucous membrane is described.

The end results of surgical and combination (radiation + surgery) treatment of 85 patients with liposarcoma are compared. The 5-year survival rate following combination therapy proved to be much higher than after surgery (84 and 53.4%, respectively). Application of radiation improves the results for treatment of all histological types of tumor, polymorphocellular liposarcoma included. Indications of standard and concentrated dose-fractionated radiation should be determined by the size of tumor.

Out of 350 hospitalized cases of esophageal carcinoma in the upper thoracic segment, stage III-IV tumors were identified in 82.8%. A retarded seeking of medical advice was chiefly responsible for the advancement of tumors. Radical surgery was performed in 32 (9.1%) patients only. The percentage of radically-treated cases could have been greater, if there had been fewer refusals to operate and to be operated on both on the part of patients and doctors who would object to surgery on the grounds of concomitant pathology or the patient's age. Radiotherapy, used in 197 (72.7%) patients as a sole method of treatment, was followed by remission in 68%.

The five-year results of surgical and combined (irradiation + operation) treatment of 451 patients with sarcoma of the soft tissues are analysed with due account for the principal prognostic factors. It is shown that the survival of patients may be prolonged if the operation is supplemented by irradiation. Comparison of three variants of combined treatment showed the advantages of combined treatment with subsequent postoperative irradiation. Radiotherapy does not increase the number of postoperative complications.

Angioscanning with macroalbumin J131 was performed in 30 patients with different mammary gland diseases (breast cancer--in 22, breast sarcoma--in 1, cystic fibroadenomatosis--in 6 and one patients without any breast pathology). Twenty eight of thirty patients were subjected to surgery, and the diagnosis was supported histologically. Injection of macroalbumin J131 in the subclavian artery enabled the authors to visualize malignant neoplasms, located mainly in the external quadrants of the mammary gland. The least size of the tumor, revealed by angioscanning, was 1.5 cm in diameter. The method of isotope injection directly in the subclavian artery, employed by the authors, may be recommended for patients, whose primary tumor is localized in the external half of the gland and in the axillary process.

The methods of treatment of 1,410 cases of soft tissue sarcoma were compared. Tumor was less than 5 cm only in 19.4% of patients admitted to the hospital by the beginning of treatment. Radical surgery was performed in 65.3% of cases, it still remaining the major procedure of treatment. Application of combined (surgery + radiation) treatment is increasingly used, every fourth patient (25.1%) being given this therapy. The percentage of radically-treated cases of soft tissue sarcoma may be raised by 15% unless patients refuse to be operated on.

Fifty one patients with bone sarcomas (42 cases) and soft tissue sarcomas (9 cases) were subjected to interscapulo-thoracic amputation. Five year survival was noted in 42,5% of cases with primary bone sarcomas. The survival was dependent first of all on the histologic character of the tumor: it is higher in chondrosarcomas (50,2%) and lower in osteosarcomas (25,4%). Interscapulo-thoracic amputation is an obligatory but helpful surgical intervention.

An analysis of data of 548 patients with different diseases of soft tissues of lower extremities after using a complex of diagnostic measures (clinical, radionuclide data, thermography, puncture, biopsy) has shown that the number of erroneous conclusions may be minimized to 2%. Modern advances of plastic surgery can widen indications for preserving operations in malignant tumors of soft tissues of lower extremities without prejudice to the main principle of oncology concerning its fascial character. Combined treatment can also improve the results.

Direct angioscintigraphy was carried out in 80 patients suspected for soft-tissue tumors in the extremities. Relevant procedure, predictive value of the diagnostic test, relationship between scintigraphic patterns and those of tumor histology as well as factors adversely affecting examination results are discussed. The method was shown to be sufficiently accurate (0.79) and may find effective application in examination of outpatients.

A project for the classification of malignant soft tissue tumors according to the TNM system is suggested for a wide discussion. The classification takes into account the effect of some leading factors (histological type of a tumor, its size, the state of regional lymph nodes, the degree of the adjacent tissues infiltration) on the prognosis of this affection. Tumors staging is done through combining various grades of T, N, M criteria.

The data reported support the idea on possible hematogenic metastases spread in esophageal cancer, especially in bones (in 5 of 209 examined patients). Clinical and roentgenological findings of esophageal cancer metastases in bones do not differ from the manifestations of osteolytic metastases in bones of malignant tumors of other localizations. Timely recognition of distant metastases in esophageal cancer seems to be important from the point of view of selecting the most rational and warranted method of treatment.

The experience with radical operations carried out upon 281 patients with malignant tumors of the soft tissues of the extremities has proved that sparing operations are more common surgical interventions (62.2%) than amputations (38.8%). The rate of the five years' survival of the patients following amputations is lower (23.6%) than following sparing operations (62.6%), which most probably depends o, the character of a lesion influencing the choice of the volume of an operation.

The authors' personal observations reported illustrate difficulties in establishing the proper diagnosis of esophageal pseudotumors. From the complex of modern diagnostic methods roentgenological and fibroesophagoscopic methods with subsequent cytologic and histological assay proved to be mostly effective. Taking into account the degree of the risk of pseudotumor lesions due to their possible malignant transformation in negative cytologic and pathomorphological findings a diagnostic thoracotomy seems to be largely recommended.