It perdormed the literature data analysis on the criteria and methods for assessing the clinical efficacy of the isolated limb perfusion method in the treatment of soft tissue sarcoma. It is noted that the use of isolated limb perfusion is a rather effective method providing local control of the tumor process in locally advanced forms of soft tissue sarcoma. It has been demonstrated that the use of such a neoadjuvant treatment regimen allows administration of the drug with the achievement of high local concentrations of chemotherapeutic drugs with a relatively low incidence of systemic side effects. Criteria for tumor response to therapy, in particular RECIST (Response Evaluation Criteria In Solid Tumors), Choi criteria, adapted for magnetic resonance imaging, are presented. It is noted that a number of studies have studied the possibility of using positron emission tomography with fluorodeoxyglucose labeled with 18F (18F-FDG) to assess the response to treatment in sarcomas. At the same time, it was shown that the results of studying the metabolic response are superior in accuracy to the method of assessment using the RECIST criteria and the assessment performed by the dynamics of the tumor tissue volume has significant potential in assessing the response to isolated limb perfusion in patients with soft tissue sarcoma. The importance of a one-time assessment of positron emission tomography with 18F-FDG parameters and Magnetic Resonance Imaging for soft tissue sarcoma is confirmed by the results of a combined analysis that takes into account both morphological characteristics and quantitative metabolic parameters of the tumor. The high potential of the combined assessment of metabolic and volume-morphological parameters obtained using these methods was demonstrated; it was noted that the combination of positron emission tomography data with 18F-FDG and Magnetic Resonance Imaging enhances the reliability and efficiency of planning and monitoring of soft tissue sarcoma treatment using the isolated limb perfusion method.

The content of calmodulin in chondrosarcomas was notably lower in patients with early relapses or generalized tumor process in comparison with patients without postoperation relapses. The mean level of calmodulin in chondrosarcomas virtually did not depend on patient's sex and age and tumor location in bones. There was a tendency to an inverse correlation between calmodulin level in chondrosarcoma and the degree of tumor differentiation. The highest level of calmodulin was detected in the cytosolic fraction of chondrosarcomas containing no estrogen and androgen receptors. Key Words: calmodulin; chondrosarcoma; steroid receptorsMultiple effects of hormones, polypeptide growth factors, and other bioactive substance modifying bone tumor growth are realized through intercellular and intracellular mediators [2,6]. One of such modulators is calmodulin (CM), a universal messenger of Ca 2+ effects in the cell [5]. CM participates in transmission of apoptotic signal in cells, in particular it activates DAP-kinase responsible for changes in cytoskeleton during apoptosis [5]. CM mediates signal of tumor necrosis factor4x by activating CM-dependent type 2 kinase responsible for DNA fragmentation during apoptosis [10]. Numerous functions of CM are regulated by many factors, and structural changes in this protein caused by various mutations modify its activity [4].We previously showed that high concentration of CM in osteogenic sarcoma (above than 6000 ng/mg) is associated with low incidence of metastases during the first 5 years of observation.In this study we measured the content of CM in chondrosarcoma (CS) homogenates and investigated the relationship between CM concentration in the tumor and MATERIALS AND METHODSThirty patients (16 men and 14 women) aged 16-70 years with CS in tubular bones (n=20) and flat bones (n=10) were examined.The morphological variants of CS were as follows: (24.1%) with the first (n--7, 24.1%), second (n--12, 41.4%) and third CS of typical histological structure with the first degree of differentiation, 12 cases (41.4%) with the second degree of differentiation, 4 cases (13.8%) with the third degree of differentiation and mesenchymal CS (n=4, 13.8%) and 3 cases with dedifferentiated CS.Calmodulin in tumor homogenates was measured by radioimmunoassay using Amersham kits.The results were processed using standard statistical software for medical data. RESULTSThe content of CM varied from 1114 to 8235 ng/mg total protein. The mean level of tumor CM in men was

Purpose: Modernization and evaluation of the clinical effectiveness of the technology of continuous radiometric monitoring carried out during high-dose chemotherapy of a surgically isolated limb with tumor foci. Material and methods: A modernized radiometric control technology for regional limb perfusion is proposed. It is based on in vivo labeling of erythrocytes with 99mTc eluate followed by continuous monitoring of the activity of labeled erythrocytes as a simulator of a chemotherapy drug over the heart region. Its distinctive features are intravenous injection of a pyrfotech slice after giving inhalation anesthesia to ensure a sufficient level of red blood cell chelation, as well as using 99mTc activity less than its minimum significant level, which allows working with an open source of ionizing radiation without violating the requirements of radiation safety regulations. Results: The developed technology was successfully used with 106 regional perfusion of the upper and lower extremities in patients with melanoma or sarcoma of soft tissues. In 4 cases, according to the results of radiometric control, the intervention of the surgical team was required to reduce the chemical preparation leakage that was occurring. Conclusion: The technology upgraded by us is characterized by ease of implementation, the ability to take timely measures to prevent or reduce the leakage of a chemotherapy drug from an isolated limb according to the results of continuous in vivo radiometric monitoring of 99mTc-labeled red blood cells over the heart, as well as low radiation load on the patient and staff.

3D printing has opened new opportunities for the development of personalized systems for prosthetics of extensive chest wall defects after radical surgical interventions for malignant tumors. However, risk factors for an adverse outcome of such operations have not yet been identified.Clinical cases. A 65-year-old man with primary chondrosarcoma of the V rib, underwent surgical resection of three ribs, plasty with local tissues, and an individual 3D printed titanium implant was installed on the sternum and IV-VI ribs. Follow up for 26 months showed no complaints or signs of recurrence. A 52-year-old woman with radiation-induced soft tissue sarcoma of the chest wall, that developed 9 years after radiation for breast cancer, underwent resection of four ribs and pectoral muscles and a 3D printed titanium implant was installed on the sternum and II-V ribs. The operation was complicated by the marginal necrosis of the soft tissue flap and infection of the endoprosthesis, which required removal of the metal structure and reconstruction using TRAM flap. After 9 months, a local recurrence of the tumor was diagnosed. Discussion. As a factor of a positive outcome in a man should be noted a thick layer of subcutaneous fat with muscle tissue, due to which plastic surgery was performed, covering the defect without tension. An extensive resection of the pectoral muscles in a woman created a tissue deficit. Another factor of an unfavorable outcome can be considered the radio-induced nature of the sarcoma. Further research is needed to improve the strategy for selecting patients with malignant tumors of the chest wall for prosthetics.

In case of locally advanced soft tissue sarcomas of the extremities (STS), the large size of which does not allow resection with preservation of the limb, isolated regional perfusion (IRP) of the limb is considered as one of the effective treatment options.Aim. To evaluate the long-term outcomes of IRP with melphalan under conditions of hyperthermia for treatment of locally advanced STS of the extremities.Materials and methods. We conducted a prospective cohort clinical study that included 42 patients with STS of the extremities. All patients underwent IRP with melphalan, in one case – in combination with tumor necrosis factor alpha. Additional lymph node dissection was performed in 8 cases (19%). The 5-year overall survival was estimated by the Kaplan-Meier method.Results. The median age of the patients was 50 years (from 24 to 80 years), women predominated – 32 (76%). STS of the upper limb was diagnosed in 14 patients (33%), of the lower limb in 28 (67%). G3 grade was verified in 34 (81%) patients, in the rest – G2. Most patients had a recurrent tumor – in 34 (81%) cases. All patients received previous treatment: surgery in combination with chemotherapy and / or radiation therapy – 36 (86%), chemotherapy alone – 2 (5%), surgery alone – 4 (9%) patients. Within 5 years, tumor recurrence developed in 20 (48%) patients, amputation was performed in 10 (24%) patients, distant metastases were diagnosed in 4 (10%) patients. The mean time to relapse after IPC was 9.3 ± 3.5 months. Overall survival at 1, 2, 3, 4, and 5 years was 98%, 88%, 86%, 74%, and 67%, respectively.Conclusion. IRP under conditions of hyperthermia with melphalan is an effective method for the treatment of STS of the extremities: the overall 5-year survival rate is 67% with a low rate of amputations and metastasis.