Study was conducted in 20 patients with osteogen sarcoma of long tubular bones. Of 20 patients studied in 11 patients tumor was localized in femoral bone, in 6 patients in tibia and in 3 patients in fibula. Slices taken from the tumor in open biopsy were the object of research. Immune-hystochemical research was carried out by the standard technique applying antibodies to Bcl-2. The assessment response was made by visual simiquantity method: expression absence was-0, weak-1 (+), moderately expressed-2 (++), intensive-3 (+++). 17 patients were given chemoradiotherapy, 3 patients combined treatment (surgical + adjuvant chemotherapy). 12 got intraarterial chemotherapy (72 hours) by CAP regimen (Cyclophosphamide, Adriamycin, Cisplatin) – 4 cycles with three week interval. Then telegammatherapy, single dose 3.5 Gy up to general dose 60–70 Gy was made, later chemotherapy was completed up to 9 cycles at the same regimen. 8 patients were carried out 4 cycles of intra-arterial chemotherapy by MP regimen (Methotrexate, Cisplatin) with three week interval. Radiotherapy used subsequently (General dose 60–70 Gy) and chemotherapy was reached up to 9 cycles at the same regimen. Research has shown, that in the most of patients 13/20 (65 %) had moderately positive and low positive expression of Bcl-2 gene, in 4/20 (20 %) cases reaction was negative and in 3/20 (15 %) cases it was the expression of the given gene that was high. The assessment of treatment efficiency was carried out by WHO recommendation. The whole effect was obtained in 6 patients (30 %), partial in 11 (55 %) and progressing was in 3 (15 %). Most patients who were given the treatment by specific scheme: chemotherapy + radiotherapy + chemotherapy had good parameters in life expectancy, where 6 of 8 patients (75 %) lived without relapse and metastases more than one year. All patients (3) had numerous lung metastases in operation + chemotherapy group of patients. Aggressive current of tumoral process was characterized with high expression of Bcl-2 gene in tumor tissue. The level of expression Bcl-2 gene can testify the efficiency of conducted treatment.
The results of treatment of 45 patients with malignant bone tumors and soft tissues of thigh proximal part and pelvis have been analyzed in the work. From 45 male patients −37 (82%), women −8 (18%). Patients’ age varied from 17-to 53 years old, in average was-33 year old. In 22 patients the tumor localized in thigh proximal part, in 17 – in the bone and soft pelvic tissues, in 2- in the buttock part and in 4- noticed metastasis lesion inguinaliliac lymph nodes. In 5 observations histological type composed from malignant gigantic cellular tumor, in 8 osteogen sarcomas, in 11-hondro-sarcomas, in 5-Ewing’s sarcomas, in 4 – fibrosarcoma of soft tissues, in 4-rabdomiosarcomas, in 1- angiosar-coma of soft tissues, in 1-leiomyosarcomas, in 1-synovial sarcomas, in 1- polymorph cellular sarcomas of soft tissues and in 4- marked metastasis lesion (mainly flat cellular skin cancer) lymph nodes of inguinal-iliac part. The complex diagnostic measures including clinic, X-ray and ultrasound diagnostics, angiography, computed magnetic – resonance tomography and morphologic investigations were carried out with all patients. A size of tumor process is 250–450cm3. In all cases carried out lymph dissection with removing of cellular tissue of pelvis till bifurcation of abdominal aorta, in 5 additionally are made sacrum resection. Duration of operational interference was from 150 to 189 minutes, and blood lost – from 1200 to 1800 ml. There were no mortality outcomes during the operation. The patients have been observed from 1 year till 12 years. During observation period from 45 patients in 4 (8%) have been determined local recurrence, in 12 (26%) – separated metastasis and in 2 (4%) –simultaneously determined recurring and separated metastasis. Findings of 3 and 5 years survival are 44,6% and 33,5%. So, interpelvic-abdominal amputation prolongs patients’ surveillance, which before is considered hopeless and mainly undergone palliative chemotherapy and symptomatic treatment.
