From 1990 to 2009, at the Research Institute of Children Oncology and Hematology have undergone examination and treatment 26 children with paratesticular rhabdomyosarcoma. The average age of our patients was 6.2 years (range 3 months to 15 years). All children was performed tumor markers level evaluation and ultrasound. In 6 children identified metastases. Surgical treatment is the first stage in the volume of orchifunikulektomia was held in 26 children. Retroperitoneal limfoadenektomiya was performed in 4 children and 1 child undergone thoracotomy with removal of metastases in the lung. Drug treatment was performed in 26 children with paratesticular rhabdomyosarcoma tumor. Using a combined method of treatment of malignant tumors led to 92.3 % overall survival.

Prostate-specific antigen is a sensitive marker for recurrent prostate cancer (PC) after radical prostatectomy (RPE), which can predict the
development of clinical progression and distant metastases well long before they occur. The objective of the investigation was to analyze the relationship of the time to biochemical recurrence (BCR) after RPE to the development of clinical progression, distant metastases, and PC death. The vast majority (80.5 %) of BCRs was common within the first 2 years after RPE and the recurrence was attended by the highest rate of clinical progression, metastases, and PC death during the first year. Correlation analysis shows that there is a statistically significant inverse correlation between the time to BCR following RPE with the development of clinical progression (rs = -0.43; p < 0.001), metastases (rs = -0.46; p < 0.001), and PC death (rs = -0.41; p < 0.001). Regardless of the time to recurrence, none of 27 patients with favorable histological characteristics (a total of post-RPE Gleason scores of ≤ 6, organ-confined disease, and a negative surgical margin) developed distant metastases; only one case had a local tumor recurrence.

In case of recurrence of prostate cancer after radiation therapy patient may be offered salvage radical prostatectomy (both open and laparoscopic/robotic), hormone therapy, and a number of alternative techniques such as salvage cryoablation, HIFU-therapy and brachytherapy. Results of monitoring of patients for 10 years after salvage treatment of prostate cancer are known only after salvage prostatectomy. Technically radical prostatectomy after radiation therapy is associated with a large number of complications if compared with primary radical prostatectomy. The most frequent complications after salvage prostatectomy include incontinence, stricture formation of urethrovesical anastomosis, rectal injury, acute urinary retention and infectious complications.

Objective: to evaluate the efficiency and safety of using the luteinizing hormone releasing hormone leuprorelin with the Atrigel delivery system in doses of 7.5, 22.5, and 45 mg as an adjuvant regimen in high- and moderate-risk cancer patients who have received high-intensity focused ultrasound (HIFU) therapy.

Subjects and methods. Moderate- and high-risk locally advanced prostate cancer (PC) patients treated with HIFU (n = 28) and HIFU in combination with hormone therapy during 6 months (n = 31) were examined.

Results. The investigation has shown that leuprorelin acetate monotherapy used within 6 months after HIFU therapy can achieve the highest reduction in prostate-specific antigen levels and positively affect the symptoms of the disease. HIFU in combination with androgen deprivation substantially diminishes the clinical manifestations of the disease and improves quality of life in HIFU-treated patients with PC, by reducing the degree of infravesical obstruction (according to uroflowmetric findings and IPSS scores), and causes a decrease in prostate volume as compared to those who have undergone HIFU only. Treatment with leuprorelin having the Atrigel delivery system has demonstrated the low incidence of adverse reactions and good tolerability.

Background. Therapy for metastatic castration-resistant prostate cancer (CRPC) is a serious problem that requires significant public health care expenditures.

Objective: to evaluate the cost-effectiveness of abiraterone treatment in patients with metastatic CRPC who previously received docetaxel under the conditions of the budgetary public health system of the Russian Federation.

Material and methods. Markovian simulation based on the COU-AA-301 randomized placebo-controlled Phase III study was used. Survival analysis was made in 70-year-old patients. The cost of abiraterone therapy corresponded to that of the 2013 auctions.

Results. Abiraterone therapy in patients who have previously received docetaxel therapy causes an increase in average life expectancy by an average of 4.6 months and progression-free survival by 2.0 months. Moreover, the cost calculated with reference to one year of additional life will account for about 3.6 million rubles and that to one additional quality-adjusted life year will be about 5.45 million rubles.

Conclusion. The cost-effectiveness of abiraterone therapy for metastatic CRPC in patients who have previously received docetaxel therapy is similar to that of other medicaments used in oncological practice under the conditions of the budgetary public health system of the Russian Federation. In this connection, abiraterone may be considered as an economically acceptable medical intervention in this clinical situation.

Background. There is a global increase in the incidence of renal cell carcinoma (RCC); more than 200 thousand new cases are recorded
every year. Despite the high (40–60 %) detection rate for localized RCC, the incidence of locally advanced and metastatic RCC (mRCC)
remains high. Tyrosine kinase inhibitors, such as sorafenib, sunitinib, bevacizumab, and pazopanib, versus cytokine therapy or placebo
demonstrated their efficacy in the treatment of mRCC during randomized trials. A randomized Phase III AXIS trial evaluating the efficacy of axitinib in direct comparison with sorafenib in patients with progressive mRCC during first-line systemic therapy has become one of the first studies comparatively investigating the targeted drugs.

Subjects and methods. The trial enrolled 723 patients with mRCC from 175 centers in 22 countries in the period September 2008 to July 2010. The patients were randomized 1:1 to either axitinib (n = 361) or sorafenib (n = 362). Of them, 389 (54 %) patients had previously received sunitinib, 251 (35 %) cytokines, 59 (8 %) bevazisumab, and 24 (3 %) temsirolimus.

Results. Median overall survival (OS) was 20.1 months (95 % confidence (CI) 16.7–23.4) in the axitinib group and 19.2 months (CI 17.5–22.3) in the sorafenib group (odds ratio (OR) 0.969; 95 % CI 0.800–1.174; p = 0.374). According to the investigator assessments, median progression-free survival was 8.3 months (95 % CI 6.7–9.2) in the patients who took axitinib and 5.7 months (CI 4.7–6.5) in those who received sorafenib (OR 0.656; 95 % CI 0.552–0.779; p < 0.0001). The most common grade III adverse reactions related to axitinib included hypertension (n = 60 (17 %)), diarrhea (n = 40 (11 %)), and fatigability (n = 37 (10 %)). The grade III adverse reactions associated with sorafenib included palmoplanar syndrome (n = 61 (17 %)), hypertension (n = 43 (12 %)), and diarrhea (n = 27 (8 %)). A detailed analysis
showed that the high registration rate of axitinib-induced hypertension was a significant prognostic factor of the efficiency of targeted therapy. Median OS in patients with hypertension developing within 12 weeks after randomization and a diastolic blood pressure (BP) ≥ 90 mm Hg was significantly longer than in those with a diastolic BP of < 90 mm Hg: 20.7 months (95 % CI 18.4–24.6) versus 12.9 months (CI 10.1–20.4) in the axitinib group (р = 0.0116) and 20.2 months (95 % CI 17.1–32.0) versus 14.8 months (95 % CI 12.0–17.7) in the sorafenib group (р = 0.0020). During a multivariate analysis, the prognostic factors associated with short-term OS included a previous treatment option (cytokines or sunitinib), ECOG somatic status = 1; a less than 1‑year interval from diagnosis to treatment initiation in the AXIS trial; more than
one metastatic focus; hepatic metastases; skeletal metastases; a hemoglobin level below the lower limit of the normal range; a corrected calcium level of > 10 mg / dl; a lactate dehydrogenase level 1.5‑fold above the upper limit of the normal range, and alkaline phosphatase or neutrophil levels greater than the upper limit of the normal range.

Conclusion. Axitinib is one of the first targeted drugs, which has demonstrated its efficacy in direct comparison with the other targeted agent sorafenib within the framework of the randomized Phase III AXIS trial in patients with progressive mRCC during first-line systemic therapy. Axitinib versus sorafenib significantly increased median progression-free survival rates in the general population of patients and in those who had previously received therapy with cytokines or sunitinib (p < 0.0001). Axitinib has a satisfactory toxicity profile and the high registration rate of hypertension associated with the drug is a significant prognostic factor for the efficiency of targeted therapy, as shown by the detailed analysis. To comply with the guidelines for monitoring BP and correcting hypertension permits long-term and effective targeted axitinib therapy.

Synchronous bilateral renal cell carcinoma occurs in 1.4 % of cases. The probability of bilateral adrenal metastases from renal cell carcinoma is less than 0.5 %. The clinical observation presents a case of synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands. A 55‑year-old male patient was adm tted with the signs of hematuria and anemia to the Unit of Urology, Clinic of General Surgery, Siberian State Medical University. He was found to have synchronous bilateral renal cell carcinoma and simultaneous bilateral adrenal involvement. Sequential surgical treatment – radical nephrectomy (with adrenal gland removal) on the right side and, after 3 months, adrenalectomy and kidney resection on the left side were performed. All the organs removed displayed tumors that proved to be renal cell carcinomas (a clear cell variant). There were lymph node metastases in the right-sided renal portal. Postoperatively, the investigators performed hormone replacement therapy for adrenal insufficiency, an immunotherapy cycle, three cycles of targeted therapy with
sorafenib and sunitinib (at an interval of 0.5–2 years), and insulin therapy for new-onset diabetes mellitus. The duration of a follow-up was 6.2 years. When describing the case, the patient was alive and showed a generalized tumorous process with extensive tumor involvement of the solitary kidney. Sunitinib therapy was used.

In spite of its existing standards, the treatment of patients with progressive prostate cancer (PC) remains a matter of debate. Ensuring that the patients have good quality of life is also relevant. The paper describes a clinical case of a patient with progressive PC after hormone therapy, brachytherapy, salvage prostatectomy, enucleation of the testicular parenchyma, and salvage lymphadenectomy. A phallic prosthesis and an artificial urinary sphincter have been implanted to improve quality of life. The results of preoperative examination and the technological features of surgical interventions are given.

Objective: to analyze the impact of surgical volume on functional results and cardiospecific survival rates in patients with clinically localized renal carcinoma.

Subjects and methods. Four hundred and fifty-three patients with pT1–3aN0M0 renal cell carcinoma and normally functioning second
kidney who had undergone radical nephrectomy (n = 226 (49.9 %)) or kidney resection (n = 227 (50.1 %)) were selected for the investigation. The patient groups who had undergone different-volume operations were matched for gender, age, body mass index (BMI), side of involvement, tumor sizes, and baseline glomerular filtration rate (GFR) (p > for all). The median baseline Charlson index and the rate of ASA classes III–IV operative risk were significantly higher in candidates for radical nephrectomy (p < 0.05 for all), the rate of diseases affecting kidney function, pT1a category, and G1 anaplasia were higher in the kidney resection group (p < 0.0001). The median follow-up was 50 (12–224) months.

Results. Within 28 days postsurgery, the rate of acute renal dysfunction (ARD) was 36.2 %. The independent risk factors of ARD were kidney resection (risk ratio (RR) = 0.210; 95 % confidence interval (CI) 0.115–0.288; р < 0.0001) and ischemia time (RR = 0.012; 95 % CI 0.004–0.021; p = 0.004). The degree of ARD after kidney resection was significantly lower than that following radical nephrectomy (p < 0.0001). In the late postoperative period, the incidence of chronic kidney disease (CKD) Stage ≥ III was 38.4 %. Its independent risk factors were low baseline GFR (RR = 0.003; 95 % CI 0.002–0.005; p < 0.0001), radical nephrectomy (RR = 0.195; 95 % CI 0.093–0.298; p < 0.0001), and ARD (RR = 0.281; 95 % CI 0.187–0.376; p = 0.0001). Ten-year specific and cardiospecific survival rates in all the patients were 98.5 and 94.9 %, respectively, and unrelated to surgical volume. The independent predictors of poor cardiospecific survival were BMI, Charlson index, and ASA risk. No relationship was found betwen cardiospecific survival and GFR in the late postoperative period.

Conclusion. Kidney resection versus radical nephrectomy significantly increases the risk of severe ARD. The scope of surgical treatment for clinically localized renal cancer has not been found to affect cardiospecific survival.

Objective: to identify the predictors of perioperative complications and deaths in surgically treated patients with kidney cancer complicated by venous tumor thrombosis.

Subjects and methods. The investigation included data on 463 kidney cancer patients with venous tumor thrombosis. The patients, median age was 57 years. The male / female ratio was 2.5:1. Perirenal, subhepatic, retrohepatic, and supradiaphragmatic tumor thrombi were diagnosed in 161 (34.8 %), 135 (29.2 %), 82 (17.7 %), and 85 (18.3 %) patients, respectively. Regional and distant metastases occurred in 90 (19.4 %) and 145 (31.3 %) cases, respectively. All the patients underwent thrombectomy, retroperitoneal lymphadenectomy; a tumor-affected kidney was removed in 452 (97.6 %) patients.

Results. Median surgery duration was 259 (30–580) min; median blood loss was 3500 (100–27 000) ml. The incidence of intraoperative complications was 24.6 % (114 / 463); mortality was 0.9 % (4 / 463). The independent risk factors of intraoperative complications were cranial margin of a tumor thrombus (odds ratio (OR) 1.9; 95 % CI 1.4–2.6; p < 0.0001) and circular resection of the inferior vena cava (OR 5.8; 95 % CI 1.2–27.8; p < 0.0001). The incidence of postoperative complications was 25.7 % (118 / 459);
mortality was 6.0 % (28 / 459). Resurgery was required in 31 (6.8 %) cases. Regression analysis identified the risk factors of postoperative complications (highly located cranial thrombus margin (OR 2.6; 95 % CI 1.1–6.4; p = 0.037) and lactate acidosis (OR
27.1; 95 % CI 1.2–613.1; p = 0.038), postoperative death (hepatic vein thrombosis (OR 15.6; 95 % CI 4.5–54.3; p < 0.0001),
lactate acidosis (OR 23.1; 95 % CI 3.4–158.4; p = 0.001) thrombus removal from the heart (OR 5.0; 95 % CI 2.1–12.2; p < 0.0001)),
perioperative death (cranial thrombus margin (OR 1.9; 95 % CI 1.2–3.2); р = 0.007), contralateral renal vein thrombosis (O R 4.4;
95 % CI 1.2–15.8; p = 0.025), lactate acidosis (OR 28.4; 95 % CI 4.9–165.1; p < 0.0001), and low creatinine clearance (OR 4.6;
95 % CI 1.9–24.9; p = 0.017).

Conclusion. Thrombectomy in patients with T3a–cNxMx kidney cancer is a technically difficult intervention associated with the high incidence of complications and death, which must be performed only in specialized centers. The identified risk factors may serve as criteria for predicting the results of thrombectomy.

The data of 60 patients with metastatic kidney cancer involving the vertebrae who had undergone different-volume surgery were retrospectively analyzed. The role of surgical volume was assessed. In patients with solitary spinal metastases, their radical removal was found to lead to better quality of life and longer survival. Puncture vertebroplasty with bone cement in patients with spinal metastatic involvement permits one to avoid traumatic fixing operations, without reducing the median survival at the same time.

The current practice in prescribing targeted agents for patients with metastatic kidney cancer (KC) is based on the results of a few large-scale multicenter randomized trials of the efficacy of different drugs in different clinical situations. Most international and national oncology and urology associations recommend 3 standard treatment options: 1) bevaсizumab in combination with interferon; 2) sunitinib; 3) pazopanib as first-line therapy in patients with good and intermediate risk metastatic KC. The valid choice of a drug for first-line therapy is one of the topical problems of real clinical practice. The criteria for choosing a drug are primarily its efficacy and toxicity profile. In addition, the specific features of a patient’s health status, the presence of different intercurrent diseases, lifestyle, and professional peculiarities also affect the choice of a treatment regimen. The paper comparatively reviews the efficacy and toxicity of bevaсizumab in combination with interferon at different doses, those of sunitinib and pazopanib, on the basis of which the choice of a drug for the therapy of patients with good and intermediate risk metastatic KC may be planned in a specific clinical situation.

Tumor grade and pT stage are significant prognostic factors in non-muscle-invasive papillary urothelial bladder carcinoma (BC) therefore  these indicators are of great importance. The purpose of the investigation was to determine whether molecular biological markers (Ki-67 level, p53, CK20, and c-erbB-2 expression) may specify the grade and invasive potential of papillary urothelial
BC. The investigators examined the specimens taken after transurethral resection of the bladder from 57 patients (46 men and 11 women) aged 24 to 75 years (mean age 56 ± 1.5 years) with non-muscle-invasive papillary urothelial BC referring to as a moderate and poor prognostic group according to the EORTC scoring system, who had received combined treatment at the Medical Radiology Research Center in 1998 to 2005 (the postoperative follow-up was 2 to 9 years).

The purpose of the investigation was to study the long-term results of reconstructive surgery in patients who had undergone simultaneous ureteral and bladder intestinoplasty. The investigation enrolled 33 patients with different bladder diseases complicated by secondary hydroureteronephrosis. After radical cystectomy, the U. E. Studer method was used to form a low-pressure orthotopic reservoir from the ileum with an afferent tubular segment in 23 (69.7 %) patients. Y-shaped ileoureterocystoplasty was carried out to recover extensive ureteral and bladder defects in 10 (30.3 %) cases. Long-term surgical results were assessed on the basis of a comprehensive examination involving laboratory, X-ray, radionuclide, and endourological studies. An isolated loop of the small bowel is a universal plastic material that may be used not only to bilaterally replace any ureteral defect, but also to simultaneously repair the bladder, by preserving independent urination.

The application of targeted and pathogenetically sound medicational approaches could considerably improve the results of therapy in patients with metastatic renal-cell carcinoma (mRCC). To date, VEGF/VEGFR inhibitors continue to remain a basic and most effective drug treatment in patients with mRCC and the choice of a drug for first-line therapy is based on the following factors: disease prognosis, a patient’s general somatic state, and the understanding of immediate therapy goals, anticipated toxicity and tolerability.
Most patients develop resistance to VEGFR inhibitors within 6–11 months after treatment initiation. The basis for resistance development may be the following mechanisms: activation of alternative proangiogenic signaling pathways, that of angiogenesis-independent progression pathways, a microenvironment-induced phenotypic change of tumor cells to form their resistance to targeted drugs, and pharmacokinetic and pharmacodynamic changes in the drug itself during therapy. To overcome resistance to VEGFR inhibitors, there are 2 possible options: 1) switching to a drug having another mechanism of action (the mTOR inhibitor everolimus); 2) that to a more selective and potent tyrosine kinase inhibitor (axitinib) that selectively affects and suppresses the activity
of the same targets – VEGFR (Vascular Endothelial Growth Factor Receptor) 1–3. As before, there is scanty convincing evidence for unique benefits in a particular succession of targeted drugs: a VEGFR inhibitor – a VEGFR inhibitor or a VEGFR inhibitor – an mТOR inhibitor. In a number of cases, the succession of prescribing of targeted drugs may be practically determined by clinical criteria, specifically by the possibility of controlling toxic complications that may be typical for VEFGR inhibitors and may accumulate in case of their successive use. It must be also remembered that VEGFR inhibitors may be successfully reused in patients who have received second- or more line therapy with targeted drugs in different succession.