[Modern prospects for polychemotherapy of solid neoplasms in children]. / Sovremennye vozmozhnosti polikhimioterapii solidnykh zlokachestvennykh opukholei u detei

To improve life quality and to increase survival in children with solid tumors, emphasis is placed on chemotherapeutical treatments along with other existing ones (surgery, radiation). By taking into account the fact that most malignant tumors in children are highly responsive to chemotherapy, programme treatment in children with neoplasms included the new drugs iphosphamide, vepeside, cisplatin, carboplatin, melfalan, bleomycin. The results of therapy with these drugs alone or in combination with well-known effective anthracycline antibiotics and plant preparations are presented. Whether more rigid modified schemes for administration and increment of dosage can be used is shown. This investigation opens new vistas for treating patients with not only localized, but disseminated forms of tumors, such as nephroblastomas, germinogenic tumors, soft tissue tumors, tumors of the bone, head, and neck. Regular assessment of the existing programmes in order to amend them, the use of new drugs, the increase of dosage and administration regimens enhance promises in treating malignant tumors in children.

[Clinical manifestations and diagnosis of childhood mediastinal tumors]. / Klinicheskie proiavleniia i diagnostika opukholei sredosteniia v detskom vozraste.

Mediastinal tumors make up as high as 7% of the malignant neoplasms in children and are encountered in all age groups, slightly more commonly in preschool children. Three main groups of common symptoms that are typical of mediastinal tumors are identified. These include 1) symptoms associated with tumor compression of thoracic organs; 2) neurological disorders associated with compression or destruction of ganglionary nodes; 3) general symptoms. Posterior mediastinal tumors are diagnosed by X-ray in 85% of cases. X-ray computed tomography makes it possible to judge of the initial site of a neoplasm, the presence of inclusions, the status of adjacent organs and tissues, the density of a pathological focus. Gallium-67 citrate radionuclide study allows one to make an early differential diagnosis between a solid formation and lymph proliferative disease. The lack of morphological verification of a diagnosis requires the use of transthoracic aspiration biopsy whose diagnostic value enhances when it is made under guidance of ultrasound or X-ray computed tomography.

[Organ-preserving surgical interventions in unilateral nephroblastomas in children]. / Organosokhraniaiushchie khirurgicheskie vmeshatel'stva pri monolateral'nykh nefroblastomakh u detei.

The paper presents data available in the literature and the authors' own findings of organ-preserving treatment of 9 children with unilateral nephroblastoma. It proposes absolute and relative indications for organ-preserving treatment in this pathology.

[Some indices of gastrointestinal tract status in children cured fro malignant neoplasms]. / Nekotorye pokazateli sostoianiia zheludochno-kishechnogo trakta u detei, izlechennykh ot zlokachestvennykh novoobrazovanii.

A total of 2255 individuals who cured from oncological diseases in childhood in Moscow in 1978 to 1997 have been studied. Most (60%) children undergone special treatment have serious visceral abnormalities. The authors examined the negative impact of a special treatment on the gastrointestinal mucosa and changes in its function after termination of special therapy in 79 cured patients. The most common diagnosed abnormalities included biliary dyskinesis (17-20%), dysbacterioris (16%), gastritis (7%). No abnormal gastrointestinal changes were detected in 37%.

[Clinical course, diagnosis and therapy of Ewing's sarcoma of the ribs in children]. / Klinika, diagnostika i lechenie sarkomy Iuinga reber u detei.

X-ray examination is considered to be the most effective procedure for diagnosis of Ewing's sarcoma of the rib. The extent of surgery and sequence of procedures are determined on the basis of its evidence. Treatment of infantile Ewing's sarcoma of the rib should include chemoradiation therapy and compulsory surgery.

[Management of nephroblastoma in children: current approaches and outlook]. / Lechenie nefroblastomy u detei: sovremennye podkhody i perspektivy.

Nephroblastoma or Wilms' tumor occurs most frequently in children. New approaches to diagnosis and treatment of this malignancy introduced for the last 15 years are reviewed. Current approaches are characterized by advances in computer noninvasive diagnostic techniques and more aggressive chemotherapy. The first line treatment is polychemotherapy (1 or 2 courses) followed by surgical intervention and postoperative drug or drug+radiation treatment. As shown by follow-up, 40% of patients with nephroblastoma stage III and IV are now free of recurrences and metastases for at least five years. Special investigations are needed to elucidate these children's quality of life, physical, social and mental fitness. Serious problems still remain in perfection of programmed treatment of children with prognostically unfavourable factors.

[Sex and pituitary hormone secretion in adolescents with osteogenic sarcoma and retarded sexual development]. / Sekretsiia polovykh i gipofizarnykh gormonov u podrostkov, bol'nykh osteogennoi sarkomoi s zaderzhkoi polovogo razvitiia.

Basal levels of secretion of total testosterone, estradiol-17 beta, their free, albumin-binding and sex steroid-binding globulin (SSBG)--binding fractions, luteinizing hormone, follicle-stimulating hormone, prolactin and somatotropic hormone were measured in blood serum in the following groups of adolescents: (1) healthy, (2) suffering primary osteogenic sarcoma of the bone, (3) osteogenic sarcoma patients with pubertal retardation, and (4) pubertal retardation. A significant increase in total testosterone fraction, free androgen index and a decrease in blood SSBG level were established in osteogenic sarcoma patients as compared to corresponding controls, irrespective of pubertal status. No difference in the above indexes for estrogens was established between osteogenic sarcoma patients and controls in both pubertal status subgroups. The role of sex steroid hormones, particularly, androgens in the pathogenesis of osteogenic sarcoma is discussed.

[The characteristics of eicosanoid synthesis in osteogenic sarcoma in children at puberty]. / Osobennosti sinteza éikozanoidov v osteogennoi sarkome detei v pubertatnom periode.

Levels of prostaglandin E (PGE), prostaglandin F2 alpha, prostacyclin A2, thromboxan B2 and leucotriene B4 assayed radioimmunologically were compared in 42 samples of osteogenic sarcoma and 22 samples of benign tumors and tumor-like lesions from children at the pubertal period. In osteogenic sarcoma samples, PGE and prostaglandin F2 alpha levels were higher than those of thromboxan B2, prostacyclin A2 and leucotriene B4. Osteogenic sarcoma revealed higher levels of the eicosanoids as compared to benign tumors and tumor-like lesions of the bone. An inverse correlation was established between PGE level and time of dissemination of osteogenic sarcoma. The role of eicosanoids in the pathogenesis of growth and dissemination of osteogenic sarcoma is discussed. The use of non-steroid anti-inflammatory drugs in complex treatment of osteogenic sarcoma of children at the pubertal period is suggested.

[Significance of therapeutic pathomorphosis in the treatment and prognosis of osteogenic sarcoma in children]. / Znachenie terapevticheskogo patomorfoza v lechenii i prognoze osteogennoi sarkomy u detei.

To decide the problem of adequacy of preoperative treatment and postoperative special therapy, it is necessary to determine the degree of therapeutic pathomorphosis of primary osteogenic sarcoma. According to the materials of the children's clinic of the All-Union Cancer Research Center, USSR AMS, the degree of impairment is dependent on the size of the neoplasm, nature of the treatment and the x-ray-morphological variant. In a group of patients given preoperative chemoradiation treatment for degrees III and IV of therapeutic pathomorphosis, the 5-year survival amounted to 37.9 and 67.2% of cases, respectively. In a weak degree of tumor lesion (I-II), only 7% of the patients survive the 5-year period without metastases. The degree of therapeutic pathomorphosis is of great importance for correcting postoperative therapy as well as for predicting the course of osteogenic sarcoma in children.

[Possibilities of endoprosthesis in osteogenic sarcoma in children]. / Vozmozhnosti éndoprotezirovaniia pri osteogennoi sarkome u detei.

Endoprostheses of the knee (14) and hip (after Sivash ) (2) joints were used in the treatment of 16 children operated on for osteogenic sarcoma at the Center Clinic. Postoperative complications leading to amputation occurred in two cases of lesions of the proximal part of shinbone . Good functional results were obtained: knee joints supplied with endoprosthesis flexed through 80 degrees. The results are only preliminary considering the relatively short period of the study but they are encouraging enough.