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Purpose To compare metastasis-related mortality, local treatment failure, and globe salvage after retinoblastoma in countries with different national income levels. Design International, multicenter, registry-based retrospective case series. Participants Two thousand one hundred ninety patients, 18 ophthalmic oncology centers, and 13 countries on 6 continents. Methods Multicenter registry-based data were pooled from retinoblastoma patients enrolled between January 2001 and December 2013. Adequate data to allow American Joint Committee on Cancer staging, eighth edition, and analysis for the main outcome measures were available for 2085 patients. Each country was classified by national income level, as defined by the 2017 United Nations World Population Prospects, and included high-income countries (HICs), upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Patient survival was estimated with the Kaplan-Meier method. Logistic and Cox proportional hazards regression models were used to determine associations between national income and treatment outcomes. Main Outcome Measures Metastasis-related mortality and local treatment failure (defined as use of secondary enucleation or external beam radiation therapy). Results Most (60%) study patients resided in UMICs and LMICs. The global median age at diagnosis was 17.0 months and higher in UMICs (20.0 months) and LMICs (20.0 months) than HICs (14.0 months; P Conclusions This international, multicenter, registry-based analysis of retinoblastoma management revealed that lower national income levels were associated with significantly higher rates of metastasis-related mortality, local treatment failure, and lower globe salvage.

During the period from 2009 to 2021, 93 patients aged 0–11 years (48 boys and 45 girls) with retroperitoneal tumors were treated. There were 66 patients with nephroblastoma and 27 patients with adrenal neuroblastoma among them. As per treatment strategies, the patients were separated into two groups: the control group and the study group. The control group (comparison) received therapy according to the protocols, whereas the study group consisted of patients who received photodynamic therapy (PDT) in addition to the standard treatment. The control group consists of 47 patients with retroperitoneal tumors, including 35 patients with nephroblastoma and 12 patients with adrenal neuroblastoma. The study group included 46 children: 31 patients with nephroblastoma and 15 patients with adrenal neuroblastoma. The 5-year survival rate in the control group was 74.5%, and it was 91.3% in the study group (p = 0.030). Recurrent tumors developed in 14.9% of the patients in the control group, while in the study group, relapse occurred in 8.7% of the patients (p = 0.357). The PDT used in this study for treatment of retroperitoneal tumors improves the results of surgical treatment. It also appreciably increases the survival rate of patients with retroperitoneal tumors. Overall, PDT is a hopeful antitumor approach and can be effectively used in the complex therapy of retroperitoneal tumors in children.

Malignant tumors of parameningeal localization are various morphological neoplasms located in the nasal cavity, nasopharynx, paranasal sinuses and middle ear. As a result of tumor growth, conditions are created for the development of chronic inflammation. Studies of the microbiome of the upper respiratory tract in children with malignant tumors were practically not conducted. Objective of the research: to identify changes in the microbiome of the nasal cavity in children with malignant tumors of parameningeal localization during chemoradiotherapy. Materials and methods: the study included 29 patients with parameningeal tumors, 2–17 years old. Among the included in the study there were 18 boys (62%) and 11 girls (37%). Morphologically, the following were verified: embryonic rhabdomyosarcoma (ERMS) – 17 (58%), alveolar rhabdomyosarcoma (arms) – 3 (10%), other sarcomas – 4 (13%), nasopharyngeal cancer – 5 (17%). All patients received induction chemotherapy. Simultaneous radiotherapy (LT) and chemotherapy (CT) – in 24 (82%) cases. After completing the chemoradiotherapy stage, consolidation therapy continued in 20 (70%) patients. Results: before the start of LT (after the induction stage of chemotherapy), a variety of microflora was observed in the nasal secretions, gram-positive and gram-negative bacteria were isolated in an equal ratio. The absence of growth of microorganisms was determined in 4 (13%) cases before the start of LT. Methicillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus were more frequently detected after LT. Colonization of the nasal cavity of Candida albicans occurred before the start of LT in 4 (13%) and persisted after irradiation in 5 (17%) patients. In the delayed period, there was an increase in the percentage of patients who ridiculed gram-negative microorganisms – Pseudomonas aeruginosa in 4 (13%) cases. After 12 months, 3 (10%) patients showed a return of nosocomial flora (S. epidermidis MRSE and S. haemolyticus MRS), a decrease in colonization of P. aeruginosa and the preservation of C. albicans. Conclusion: at different stages of chemoradiotherapy, the nasal mucosa is colonized by various microorganisms that differ in their properties and pathogenicity. The continuation of this study will clarify the clinical significance of certain types of opportunistic microorganisms in the pathogenesis of inflammatory diseases of the upper respiratory tract in children with malignant tumors.

Rationale: The known prognosis factors for rhabdomyosarcoma (RMS) in children do not always explain the unsatisfactory outcome of treatment. Changes in the subpopulation composition of Bone Marrow (BM) effector cells during the development of RMS may indicate new directions for the search for prognostic factors and points for the impact of targeted therapy. Purpose: To identify correlations between quantitative changes in the levels of subpopulations of T, B and NK-lymphocytes of BM and known risk factors for RMS in children. Objects: The study included 31 patients. The main group included 16 patients with RMS, average age—6.8 ± 1.0 years, while children 1 - 10 years old—13 (81.3%), over 10 years old—3 (18.8%) people, girls and boys were 8 people each. The embryonic variant of RMS was established in 10 (62.5%) cases, the alveolar variant—in 4 (25%) cases, in two patients (12.5%), the histological variant was not established. In 12 (75%) patients, an unfavorable localization of the RMS (parameningeal, extremities, prostate, bladder) was revealed, in 4 patients (25%), the localization of the tumor was regarded as favorable. Patients with T2b—13 (81.2%) and T2a—2 (12.5%) stages prevailed. Regional and distant metastases were detected in 10 (52.6%) patients. The comparison group included 15 children in whom the presence of malignant neoplasia was excluded, the average age was 8.4 ± 1.5 years, 11 boys (73.7%) and 4 girls (26.3%). Methods: All patients underwent morphological (myelogram counting) and immunological (quantitative analysis of lymphocytic subpopulations) bone marrow studies. Immunophenotyping in all patients was carried out by direct immunofluorescence using a triple fluorescent label. Results: Significant differences in the levels of subpopulations of BM T-lymphocytes were found when comparing the values of the main group, distributed by localization and histological variant, with the data obtained in the control group of patients. For example, the percentage of CD3+ T cells with the co-stimulatory molecule CD28+ was significantly higher in patients with parameningeal RMS (p = 0.010). Conclusion: Each clinical group of patients has its own individual immunological characteristics. The results obtained by us can be considered indicative and regarded as starting points for further study of the peculiarities of the subpopulation composition of BM in patients with RMS.

Purpose To evaluate the ability of the American Joint Committee on Cancer (AJCC) 8th edition to predict local tumor control and globe salvage for children with retinoblastoma (RB). Design International, multicenter, registry-based retrospective case series. Participants A total of 2854 eyes of 2097 patients from 18 ophthalmic oncology centers from 13 countries over 6 continents. Methods International, multicenter, registry-based data were pooled from patients enrolled between January 2001 and December 2013. All RB eyes with adequate records to allow tumor staging by the AJCC 8th edition criteria and follow-up to ascertain treatment outcomes were included. Main Outcome Measures Globe-salvage rates were estimated by AJCC clinical (cTNMH) categories and tumor laterality. Local treatment failure was defined as use of enucleation or external beam radiation therapy (EBRT), with or without plaque brachytherapy or intra-arterial chemotherapy (IAC). Results Unilateral RB occurred in 1340 eyes (47%). Among the 2854 eyes, tumor categories were cT1 to cT4 in 696 eyes (24%), 1334 eyes (47%), 802 eyes (28%), and 22 eyes (1%), respectively. Of these, 1275 eyes (45%) were salvaged, and 1179 eyes (41%) and 400 eyes (14%) underwent primary and secondary enucleation, respectively. The 2- and 5-year Kaplan–Meier cumulative globe-salvage rates without the use of EBRT by cTNMH categories were 97% and 96% for category cT1a tumors, 94% and 88% for cT1b tumors, 68% and 60% for cT2a tumors, 66% and 57% for cT2b tumors, and 32% and 25% for cT3 tumors, respectively. Risk of local treatment failure increased with increasing cT category (P Conclusions Multicenter, international, internet-based data sharing validated the 8th edition AJCC RB staging to predict globe-salvage in a large, heterogeneous, real-world patient population with RB.

Purpose To evaluate the ability of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual to estimate metastatic and mortality rates for children with retinoblastoma (RB). Design International, multicenter, registry-based retrospective case series. Participants A total of 2190 patients from 18 ophthalmic oncology centers from 13 countries over 6 continents. Methods Patient-specific data fields for RB were designed and selected by subcommittee. All patients with RB with adequate records to allow tumor staging by the AJCC criteria and follow-up for metastatic disease were studied. Main Outcome Measures Metastasis-related 5- and 10-year survival data after initial tumor staging were estimated with the Kaplan–Meier method depending on AJCC clinical (cTNM) and pathological (pTNM) tumor, node, metastasis category and age, tumor laterality, and presence of heritable trait. Results Of 2190 patients, the records of 2085 patients (95.2%) with 2905 eyes were complete. The median age at diagnosis was 17.0 months. A total of 1260 patients (65.4%) had unilateral RB. Among the 2085 patients, tumor categories were cT1a in 55 (2.6%), cT1b in 168 (8.1%), cT2a in 197 (9.4%), cT2b in 812 (38.9%), cT3 in 835 (40.0%), and cT4 in 18 (0.9%). Of these, 1397 eyes in 1353 patients (48.1%) were treated with enucleation. A total of 109 patients (5.2%) developed metastases and died. The median time (n = 92) from diagnosis to metastasis was 9.50 months. The 5-year Kaplan–Meier cumulative survival estimates by clinical tumor categories were 100% for category cT1a, 98% (95% confidence interval [CI], 97–99) for cT1b and cT2a, 96% (95% CI, 95–97) for cT2b, 89% (95% CI, 88–90) for cT3 tumors, and 45% (95% CI, 31–59) for cT4 tumors. Risk of metastasis increased with increasing cT (and pT) category (P Conclusions Multicenter, international, internet-based data sharing facilitated analysis of the 8th edition AJCC RB Staging System for metastasis-related mortality and offered a proof of concept yielding quantitative, predictive estimates per category in a large, real-life, heterogeneous patient population with RB.

Simple Summary Breastfeeding has been shown to lower the risk of oncogenesis in many pediatric cancers, with longer periods of breastfeeding having the most protective effect. However, an association has not yet been determined for the consequence or benefit of breastfeeding in retinoblastoma (RB), the most common intraocular malignancy of childhood affecting 8000 children worldwide each year. Herein, we aimed to understand the role of breastfeeding in the severity of development of nonhereditary RB, specifically its relationship to age at diagnosis, ocular prognosis, and extraocular involvement. Our analysis of 344 patients indicated that neither breastfeeding nor formula feeding was associated with differences in age at diagnosis, ocular prognosis, or extraocular involvement. More research elucidating the factors affecting the development of RB is warranted both to understand the pathophysiology of tumor development and to develop clinical recommendations for preventive care. Abstract The protective effects of breastfeeding on various childhood malignancies have been established but an association has not yet been determined for retinoblastoma (RB). We aimed to further investigate the role of breastfeeding in the severity of nonhereditary RB development, assessing relationship to (1) age at diagnosis, (2) ocular prognosis, measured by International Intraocular RB Classification (IIRC) or Intraocular Classification of RB (ICRB) group and success of eye salvage, and (3) extraocular involvement. Analyses were performed on a global dataset subgroup of 344 RB patients whose legal guardian(s) consented to answer a neonatal questionnaire. Patients with undetermined or mixed feeding history, family history of RB, or sporadic bilateral RB were excluded. There was no statistically significant difference between breastfed and formula-fed groups in (1) age at diagnosis (p = 0.20), (2) ocular prognosis measures of IIRC/ICRB group (p = 0.62) and success of eye salvage (p = 0.16), or (3) extraocular involvement shown by International Retinoblastoma Staging System (IRSS) at presentation (p = 0.74), lymph node involvement (p = 0.20), and distant metastases (p = 0.37). This study suggests that breastfeeding neither impacts the sporadic development nor is associated with a decrease in the severity of nonhereditary RB as measured by age at diagnosis, stage of disease, ocular prognosis, and extraocular spread. A further exploration into the impact of diet on children who develop RB is warranted.

Simple Summary The authors aimed to determine the lag time between onset of symptoms and diagnosis of retinoblastoma in countries based on their national-income and analyse its effect on the outcomes. Based on analysis of 692 retinoblastoma patients from 11 treatment centres in 10 countries, there was a statistically significant difference in the lag time between onset of symptoms and diagnosis of retinoblastoma based on country income level. This difference in the lag time between different countries results in varied outcomes across patients. Shorter lag time results in better chances of eye and patient survival. Abstract Background: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its effect on the outcomes. Methods: We performed a prospective study of 692 patients from 11 RB centres in 10 countries from 1 January 2019 to 31 December 2019. Results: The following factors were significantly different among different countries based on national-income level: age at diagnosis of RB (p = 0.001), distance from home to nearest primary healthcare centre (p = 0.03) and mean lag time between detection of first symptom to visit to RB treatment centre (p = 0.0007). After adjusting for country income, increased lag time between onset of symptoms and diagnosis of RB was associated with higher chances of an advanced tumour at presentation (p < 0.001), higher chances of high-risk histopathology features (p = 0.003), regional lymph node metastasis (p < 0.001), systemic metastasis (p < 0.001) and death (p < 0.001). Conclusions: There is a significant difference in the lag time between onset of signs and symptoms and referral to an RB treatment centre among countries based on national income resulting in significant differences in the presenting features and clinical outcomes.

BackgroundThe travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.MethodsA cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.ResultsCapture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, pConclusionsFewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

В представленных клинических рекомендациях обсуждаются современные подходы к диагностике и лечению дифференцированного рака щитовидной железы у взрослых. Изменения в настоящей редакции Клинических рекомендаций касаются показаний к пункционной биопсии, скринингового определения концентрации кальцитонина, унификации заключений цитологического исследования, новых подходах к послеоперационной динамической стратификации риска рецидива, показаний к супрессивной и заместительной терапии, таргетной терапии йоднегативных форм дифференцированного рака щитовидной железы.

The article describes the history of the selection of pediatric oncology as a separate specialty, the organization of first oncological departments and the creation of the first in the USSR Research Institute of Pediatric Oncology and Hematology. There is described the role of academician L.A. Durnov as the founder of oncopediatrics in the national health care

Multiple mutations in RET proto-oncogene are not common findings in patients with multiple endocrine neoplasia type 2A syndrome (MEN2A). Screening for RET mutation in MEN2A family members is usually limited by the known affected exon. However the second unrevealed mutation in RET proto-oncogene can coexist and modify the phenotype of MEN2 patients, including age of onset of medullary thyroid carcinoma, penetrance of pheochromocytoma etc. We here describe a family with MEN 2A syndrome with combination of three different germ-line RET mutations in its members (RET codon C634R, C634R+I852M, I852M+Y791F, Y791F). The earliest onset of medullary thyroid carcinoma was in a patient harboring the C634R+I852M double mutation at age 24 years. A 49-y.o.patient with C634R mutation has persistent medullary thyroid carcinoma after thyroidectomy at 35 years old. A carrier of Y791F mutation had no clinical evidence of disease at age of 28 years. In a child with compound I852M+Y791F mutation preventive thyroidectomy revealed C-cell hyperplasia at age of 4 years. The clinical significance of double RET mutation in the described family is not clear. Literature data of multiple germ-line RET mutations in patients with multiple endocrine neoplasia type 2A syndrome are presented.

Ischemic stroke (AI) is becoming an increasingly important and urgent problem in pediatrics due to the occurrence of neurological disorders that affect the quality of life and limit the social adaptation of a child. The clinical picture of ischemic stroke in pediatric practice differs from the manifestation of this pathology in adult patients. Children have special risk factors for the development of IS. In pediatric oncology, there are such factors like invasive tumor growth, the development of tumor embolism, and blood clotting disorders. Side effects of anticancer treatment occupy a special place in the development of IS. The relationship between post-radiation arteriopathies and ischemic stroke has been more studied among cancer patients who underwent neck irradiation. In children, it was found that after radiation therapy to the head and neck region and, thus, the risk of ischemic stroke in childhood increases. This review is devoted to the possible pathophysiological causes and mechanisms of stroke in children with head and neck tumors. In addition, descriptions of clinical cases of patients with ischemic stroke in the course of anticancer treatment are presented.

Introduction. The large size of the Russian Federation, different size and density of the child population in the regions of the country require for careful planning organization of care for children with cancer and the rational use of available resources, since in spite of the significant progress made in pediatric oncology, malignant neoplasms (External testing) are the second most common cause of the death in children. Purpose of the study. Perfection of the organizational-methodological approaches to care for children with cancer in Russia in order to improve the quality and effectiveness of treatment. Material and methods. In a non-randomized non-controlled study there were included reports of regional ministries and departments of health from 83 subjects of the Russian Federation for 2013. Results. The highest incidence rate of malignant tumors (per 100,000 ofpopulation agedfrom 0 to 17 years) was registered in the Lipetsk region - 21.7, the lowest - in the Republic of Tyva - 5.5. The number of patients newly diagnosed in 2013 was the highest in the Central and Volga Federal Districts - 775 and 653, respectively. The smallest - in the Far Eastern Federal District - 138. The number of primary patients referred to the federal clinic, was the largest in the North Caucasus Federal District (North Caucasus Federal District) - 80%, the lowest - in the South - 32.5%, the largest number of doctors who do not have primary specialization in “Children’s oncology”, was registered in the North Caucasus Federal District and the Volga Federal District - 50%, the lowest - Urals - 14.2%. Total in Russia 51 children’s oncological department operate, while the number of beds in which we treat these patients, including beds in non-core branches is 2021. 390 doctors treat children with cancer, out of which 252 (64, 6%) did not have a certificate in pediatric oncology. In 2013, 33 78 children were registered with the External testing, 1705 (50.5%) of them were directed for the management in federal clinics. Conclusion. It is necessary to improve further the existing vertical provision of high-tech medical care for children with cancer, the creation of regional cancer registers, certification of specialists and the quality control of medical care through the implementation of internal and external audit.

Genetically caused medullary thyroid cancer (MTC) is associated with unfavorable survival prognosis, so it makes necessary to develop new diagnostic techniques to reveal pre-clinical stage of disease as well as to introduce into clinical practice the effective method of tumor prevention. The article represents first in Russia summary clinical experience of prophylactic thyroidectomy have been executed in the period 1998 – 2015 yeas among ten bearers of RET gene germlinemutation in families with hereditary disease including syndrome MEN2A and familial MTC. Aim : to evaluate the results of surgical treatment of asymptomatic carriers of germinal mutations in the RET gene. Materials and methods . In the period from 1998 to 2015, in two centers: N.N. Blokhin Russian Cancer Research Center, Moscow and A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Obninsk was conducted prophylactic surgical treatment in 10 patients – asymptomatic carriers of germinal mutations in RET. Age of patients – from 2 to 23 years old. 9 patients – from families with the syndrome of multiple endocrineneoplasia type 2A (MEN2A), one – with the family of MTC. According to genealogy in 9 families of patients there have been cases of death from MTC or pheochromocytoma (PC). In all cases, surgical treatment was performed in a volume of TE, two patients additionally performed lymph node dissection VI level. The observation period after surgery ranged from 6 months to 16 years. Results . DNA diagnostics in 8 patients identified a mutation in exon 11, in one case – in exon 10 and one patient had revealed two mutations in exons 13 and 14. The age of patients ranged from 2 to 23 years. Basal calcitonin level was elevated in 7 of 10 patients. Such prophylactic TE in 2 patients was supplemented by selective lymph node dissection. Histological examination of the removal of the thyroid gland (TG) revealed foci of medullary cancer in 6 of 10. At 2 patients revealed a C-cell hyperplasia and at 2 patients were found signs of the well expressed and weakly expressed sclerosis in thyroid tissue. The earliest age to identify MTC was a child 3 years old, mutations in codon 634, from a family where relatives observed for aggressive MTC. In the course of follow-recurrence was detected in one patient, a child of 15 years, a similar mutation carrier. Conclusion . In view of the risk of MTC developing identifying a mutation in RET gene and preventive TE should be carried out as soon as possible. The high risk of MTC developing in RET-gene positive subjects was confirmed in this study (6 cases of cancer from 10 patients).

The article contains important issues about functioning of technical means and engineering systems of cities as sources of the human impact on the surrounding ecosystem, namely, the study of the functioning of boiler plants as sources of the human impact on a condition of the atmospheric air located near urbanized areas. So, we solved the problem of improving standardization systems, licensing, certification, environmental safety requirements, design and research activities in the building and operation of municipal services, in particular, improving methods of forecasting air pollution by solid particles contained in emissions released from the production of heat and electricity by burning coal. We made studies and mathematical treatment of the dispersed composition of dust emitted from the organized (boilers) and unorganized (ash dumps) boiler emissions sources, we established that solid particles are entered in the atmospheric air and most of them has a size up to 20μm. We got expressions for determining the sedimentation rate of fine particles of ash and slag.

Introduction. Chemotherapy is the definitive treatment for children with cancer. Intravenous administration is the most common method of chemotherapy, since most chemo drugs are easily absorbed through the blood. Thus a long-term venous access is one of the most important and urgent aims of pediatric oncology. Materials and methods . A total of 246 patients aged 2 months to 17 years were included in the analyses. Implanted venous access port systems (IVAPS) implantation was performed in all the patients during the period of 2006-2015. Results . We observe the following complications and technical difficulties in 42 (17%) patients: accidental carotid artery puncture during attempted internal jugular vein (IJV) puncture — 16 (6.5%) cases, retrograde positioning of the distal end of the guidewire in the IJV — 21 (8,5%) cases; insertion of guide wire's distal tip into the punctured SV — 12 (4,9%) cases; difficulties during catheter advancement into the IJV after successful puncture — 26 (10,6%) cases. The following complications were detected venous port contamination — 17 cases (6,9%); occlusion of the IVAPS by a clot — 34 cases (13,8%); subcutaneous fat layer thinning above the port chamber — 2 cases (0,8%). Conclusion . Complications reported in our study (75 cases) were not fatal, mostly preventable, and have not led to protocol violations in the treatment of children with cancer. However, it should be highlighted that there is a need in further training of nurses and doctors in order to disseminate the proposed procedures in other clinics of the Russian Federation and reduce the number of operational complications.

The article presents recent clinical manifestations of the central nervous system tumors, bone or soft tissue malignancy, abdominal and retroperitoneal tumors in children and adolescents. We demonstrate the incidence of the guiding symptoms that determine the severity of the condition of patients with incurable cancer.

Introduction. The article presents the five-year experience of implantation and maintenance of venous access systems in children with cancer, and provides the clinical and economic analysis of this type of manipulation. Basing on the sales statistics and the results of the training of medical personnel the analysis of the availability of implantable venous port systems in the clinics of the country was conducted. Materials and methods. The analysis included data on 2,262 patients aged from 2 months up to 17 years, who had been taking a course of chemotherapy in 2010-2014 and were implanted different venous access systems: 2099 children (92.8%) — 3930 external central venous catheters and 163 (7.2%) — 163 implantable venous port systems. Results. Complications in patients with external central venous catheter occurred in 11.8% of cases, technical difficulties — in 72.9%, 55.8% of which were corrected intraoperatively. Maintenance complications were noted in 61.7% of cases, 44% of which required removal of the outer central venous catheters. Complications in patients with implanted port systems occurred in 4.3% of cases, technical difficulties — in 29.4% but all the complications were corrected intraoperatively. Maintenance complications were noted in 15.9% of patients. They were caused by improper operation of the port systems. It resulted in the removal of 2.4% port systems. Conclusion. Maintenance of implantable venous port systems carries the lowest risk of complications, and is more economical. One of the few deterrents for their mass adoption is the lack of a sufficient number of qualified medical personnel able to deal with the implantation and maintenance of long-term venous access. Another reason — the lack of required radiological and ultrasound equipment in clinics.

ВВЕДЕНИЕ Остеосаркома — первично злокачественная опухоль костей, которая развивается из примитивных мезенхимальных стволовых клеток, способных дифференцироваться в костную, хрящевую или фиброзную ткани; составляет 3% всех злокачественных опухолей у детей и подростков. Частота встречаемости — 4 случая на 1 млн детского населения в год, что составляет 35–50% всех злокачественных опухолей костей в детском возрасте [1, 2]. DOI: 10.15690/onco.v2.i4.1467 А. Штернхайм , Д. Левин , М. Министерский , А. Ниркин , Дж. Бикелс , С. Дадиа , Е. Коллендер , Е. Гортзак , М.Ю. Рыков, Э.Р. Сенжапова, А.З. Дзампаев, В.Г. Поляков 4 1 Клинический центр педиатрии Дана-Дуэк, Тель-Авив, Израиль 2 Медицинский центр им. Э. Сураски, Тель-Авив, Израиль 3 Российский онкологический научный центр им. Н.Н. Блохина Минздрава России, Москва, Российская Федерация 4 Российская медицинская академия последипломного образования Минздрава России, Москва, Российская Федерация

ВВЕДЕНИЕ Роль венозного доступа в лечении онкологических заболеваний сложно переоценить. Именно эта «мелочь» способна не только привести к тяжелым осложнениям и повлиять на прогноз заболевания, но и существенно повысить его стоимость, нанося и без того небольшому бюджету здравоохранения существенный урон [1]. М.Ю. Рыков1, О.А. Кириллова1, В.Г. Поляков1, 2 1 Российский онкологический научный центр им. Н.Н. Блохина, Москва, Российская Федерация 2 Российская медицинская академия последипломного образования МЗ РФ, Москва, Российская Федерация

Цель. Изучение влияния различных режимов лазерного излучения и фотодинамической терапии на сосудистое русло и активность ангиогенеза карциномы Эрлиха в эксперименте. Материалы и методы. Исследование изменений сосудистого русла в экспериментальной карциноме Эрлиха при фотодинамической терапии в комбинации с лазерным излучением проведено на 144 белых беспородных мышах линий CBA, C57BI, C3HA, гибридах F (CBA* C57BI) с перевитой в подкожную клетчатку спины асцитической карциномой Эрлиха. В зависимости от дозы лазерного излучения животные разделены на 4 группы и группу контроля. Результаты. Величина плотности лазерного излучения определяла степень деструкции тканей. Стереотипные необратимые расстройства кровообращения во всех группах сопровождались уменьшением васкуляризации и экспрессии ростового фактора ангиогенеза в ткани опухоли. Заключение. Значительное уменьшение объема и площади ткани опухоли получено при сочетанном применении фотодинамической терапии и лазерного излучения в дозе 400 Дж/см2.

Purpose To review our experience with implantable venous port-systems (IVPs) in pediatric cancer patients. Materials and Methods From 2010 to 2015 we were monitoring the treatment of 163 children (aged 3 months to 17 years) with oncologic diseases. These patients underwent venous port implantations. Results During insertion of 163 IVPs the following complications and technical difficulties were present: unintended puncture of the common carotid artery (CCA) during the puncture of the internal jugular vein (IJV) - 7 cases (4.3%); retrograde positioning of the distal end of the guidewire in the IJV - 17 cases (14.4%); placement of the distal end of the guidewire into the punctured subclavian vein (SV) - 12 cases (7.6%); difficulties driving the guidewire into the IJV after successful puncture - 15 cases (9.3%). The use of 163 IVPs was complicated by the following: venous port contamination - 4 cases (2.5%); occlusion of the IVPs by a clot - 8 cases (5%); withdrawal of the Huber needle bevel from the port chamber - 22 cases (13.6%); subcutaneous fat layer thinning above the port chamber - 3 cases (1.7%). Conclusions There are many complications, but they can be reduced by proper choice of materials and methodology.