Purpose of the study. To represent the results of a two-stage surgical treatment in patients with extensive pelvic bone defects. Materials and methods. Data on 7 patients who underwent surgery for pelvic and sacrum tumors at the National Medical Research Centre for Oncology from 2016 up to 2020 are presented. The average age of the patients was 36 years. Patients with massive tumors that required a major resection of the posterior pelvis and the formation of an extensive bone defect requiring reconstruction with massive allografts and implants were selected for the study. 5 patients underwent different variations of sacrectomies with the resection of the iliac bones; 2 patients -interiliac-abdominal resections. For all these patients, surgical treatment was split into 2 stages. Results. At the first stage we performed: 5 surgical interventions (total or extended sacrectomy at L5-S1 with lumbar-iliac bilateral stabilization with an 8-screw pedicle system) in patients with sacral tumors. In 2 cases, an interilio-abdominal resection with the defect replacement with cement articulating spacer. Intraoperative blood loss on average was 1.8L. We used autohemotransfusion to compensate the intraoperative blood loss. The 2nd (reconstructive) stage was completed on average after 3 months. The reconstructive stage was not accompanied by major trauma in all patients. The average blood loss was approximately 800 ml. There were no complications after the reconstructive surgical stage. Conclusion. The described two-stage technique allowed to avoid severe infectious complications requiring removal of implants and grafts in all patients. Adequate spinal pelvic stabilization and/or spacing of the defect contributed to early functional rehabilitation of patients and the continuation of adequate adjuvant therapy in the interstage period. The delaying of the reconstruction allowed to reduce the duration and invasiveness of the main intervention without affecting the final result of treatment.
Introduction. Soft tissue sarcomas (STS) are rare diseases but their characteristic tendency for recurrence and high mortality dictate the need for the search for prognostic biomarkers for identification of patients with the risk of recurrence. In this context, the system of insulin-like growth factors (IGF) and their insulin-like growth factor-binding proteins (IGFBP) is of interest because it was shown that disruption of the IGF system regulation leads to cancer cell proliferation and migration and chemotherapy resistance.The study objective is to investigate the levels of the IGF system components in blood of patients with primary and recurrent STS.Materials and methods. In total, 54 patients with STS, T2bN0M0, were examined: 12 men and 12 women with primary STS, 10 men and 20 women with recurrent STS, as well as healthy donors (10 men and 10 women). Mean patient age was 63.1 ± 0.9 years. In blood sampled prior to treatment, the levels of insulin-like growth factor 1 (IGF1), insulin-like growth factor 2 (IGF2) and insulin-like growth factor-binding protein 2 (IGFBP2) were measured by ELISA using Mediagnost kits (Germany). Statistical analysis was performed using Statistica 10 software and non-parametric Mann-Whitney test.Results. In primary STS, the levels of IGF1 in men with G3–4 tumors and all women decreased 14- and 20-fold, respectively, compared to healthy donors. Additionally, an insignificant decrease of IGF2 level in men and a decrease of IGF1/IGF2 ratio by the factor of 8.8 in men with G3–4 tumors and by the factor of 24.3 in women were observed. In recurrences, IGF1 level decreased by 40 % in men and by 78–85.5 % in women, while IGF2 level in men with G3–4 tumors decreased by 19 %, in women increased by 21–58 % compared to donors. In women with primary STS and recurrences of G3–4 tumors, IGFBP2 was also elevated. In men with G3–4 tumors, changes in IGFBP2 levels were less significant and had an opposite trend compared to women.Conclusion. STS recurrence is accompanied by imbalance of IGF system components in blood, especially in patients of both sexes with G3–4 tumors. Correlation between increased IGFBP2 level in STS and clinical characteristics of the disease, especially in recurrence, suggest prognostic significance of this molecule.
Цель исследования. Оценить эффективность и возможность широкого клинического использования препарата деносумаб в неоадъювантном режиме у больных с гигантоклеточной опухолью костей для упрощения выполнения операции за счёт уменьшения размеров опухоли, консолидации патологических переломов, улучшения качества жизни, восстановления функции смежных суставов, путём проведения 2-х курсов деносумаба в качестве неоадъювантной таргетной терапии больным с гигантоклеточными опухолями костей, а также оценки морфологических изменений в опухоли. Материалы и методы. Учитывая данные об эффективности деносумаба, всем 10 пациентам было проведено 2 курса деносумаба 120 мг подкожно 1 раз в месяц в качестве неоадъювантной таргетной терапии по поводу гигантоклеточной опухоли кости перед проведением хирургического лечения. Осуществлено изучение морфологической картины до и после лечения, а также оценены клинико-рентгенологические результаты. Результаты. Во всех 10 наблюдениях была отмечена однотипная клиническая картина, выражавшаяся в уменьшении болевого синдрома, восстановлении функции конечности. Рентгенологические изменения позволили констатировать развитие склеротических процессов в очагах литической деструкции. В местах патологических переломов наблюдали их консолидацию. Основные изменения, обусловливающие клиникорентгенологические характеристики были связаны с морфологическими процессами, происходящими в опухоли под действием деносумаба. Морфологическая картина в удаленных операционных препаратах костей была связана с развитием фиброзносклеротических процессов, приводящих к консолидации патологических переломов. Гистологические изменения были оценены на светооптическом уровне. При этом происходило замещение опухолевых клеток (остеобластов и остеокластов) фиброзной тканью разной степени зрелости. То есть под действием деносумаба наблюдался ответ от проводимой терапии (патоморфоз в опухоли). Заключение. Данный способ применения деносумаба в качестве неоадъювантной таргетной терапии больных с гигантоклеточными опухолями костей перед проведением хирургического лечения позволяет добиться уменьшения размеров опухоли, консолидации патологических переломов. Под действием препарата в ходе лечения происходило восстановление функции смежных суставов. Было отмечено улучшение качества жизни пациентов. Доказательством клинико-рентгенологического эффекта проводимой терапии являлись морфологические изменения, происходящие в опухоли. Всё вышеизложенное давало возможность выполнения оперативного вмешательства.
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