Background. Therapy with immune checkpoint inhibitors (antibodies against PD-1) has become a standard of treatment of patients with metastatic renal cell carcinoma (mRCC) resistant to tyrosine kinase inhibitors. Objective: to identify reliable immunological markers predicting mRCC sensitivity to nivolumab therapy to increase its effectiveness and facilitate its more rational application.

Materials and methods. The article presents an analysis of treatment of 23 patients with mRCC who received nivolumab under the expanded access program. Objective response rate in this group was 21.7 %. Median progression-free survival was 4 months (95 % confidence interval was 1.37–10.04). Median overall survival wasn’t reached for median follow-up duration of 10 months (3–14 months); grade III–IV complications were observed in 13 % of cases.

Results. During nivolumab therapy, factors positively affecting progrerssion-free survival were presence of clinical effect, favorable prognosis per the Memorial Sloan Kettering Cancer Center criteria, development of hypothyroidism, baseline serum levels of interleukin-17А and sPD-1 above the threshold values. Baseline increased serum concentration of TGF-β1 compared to the threshold level (20 ng/ml) was a negative prognostic factor for nivolumab immunotherapy. The number of previous therapy lines, PD-L1 and FOXP3 expression on tumor-infiltrating lymphocytes didn’t significantly affect progression-free survival. Effectiveness and toxicity profile of nivolumab in this series of observations conformed to the results of the phase III clinical trial. The drug was characterized by high tolerability.

Conclusion. The study results demonstrated lower toxicity and high tolerability of nivolumab compared to previously registered targeted drugs. Low rate of adverse events allows to study nivolumab in combined or subsequent/alternating modes of treatment with other immune checkpoint inhibitors and targeted drugs.

Objective: to assess advisability of nephrectomy, inferior vena cava (IVC) thrombectomy in renal cell carcinoma (RCC) with tumor venous thrombosis and pulmonary metastases.

Materials and methods. We analyzed medical data of 112 consecutive RCC patients with tumor venous thrombosis and pulmonary metastases undergone nephrectomy, IVC thrombectomy at N.N. Blokhin Cancer Center from 1971 to 2014. Median age was 57 (19–77) years,  a male-to-female ratio – 4.1:1. Tumor venous thrombosis occurred in all patients and achieved levels III–IV in 36 (32.1 %) cases. Ten (8.9 %) patients had solitary, 102 (91.1 %) – multiple lung metastases. Nephrectomy, thrombectomy was performed in all cases, 10 (8.9 %) patients also underwent complete resection of all pulmonary lesions. Eighty-eight (78.6 %) patients managed to receive systemic therapy. Median follow-up – 24 (3–148) months.

Results. Median operative time was 185 (70–380) min, median blood loss – 4000 (200–18 000) ml. Intraoperative complications occurred in 25 (22.3 %), postoperative – in 37 (33.0 %) patients (Clavien–Dindo grade III–V – 27 (24.1 %)). Mortality rate was 9.8 %. Five-years overall and cancer-specific survival in all patients were 22.3 and 24.0 % respectively (median – 21.0 ± 3.6 and 21.0 ± 2.9 months respectively). Independent negative prognostic factors for cancer-specific survival were tumor pulmonary embolism before surgery (hazard ratio 269.4; 95 % confidence interval 112.4–314.6; р = 0.021) and contralateral renal vein tumor thrombosis (hazard ratio 83.1; 95 % confidence interval 78.2–178.3; р = 0.011).

Conclusion. Nephrectomy, IVC thrombectomy is justified in selected RCC patients with tumor venous thrombosis and lung metastases without pulmonary embolism before surgery and contralateral renal vein tumor thrombosis. Nephrectomy, IVC thrombectomy is associated with acceptable complications rate and provides long-term survival comparable with the results of simple cytoreductive nephrectomies in historical series.

Objective: to compare the predictive value of RENAL, PADUA, C-index nephrometry score systems according to projection of complexity  of operative measure in terms of warm ischaemic time, extent of blood loss and rate of postoperative complications.

Materials and methods. Information for the research was collected from 314 patients with localized kidney cancer, who had laparoscopic partial nephrectomy from January 2012 to May 2017. In 210 (66.8 %) cases, in addition to the routine examinations, 3D modelling and operative measure planning were carried out. The average tumor volume of the patients was equal to 62.5 ± 33.5 mm³. All patients before  the operation were estimated the complexity of operative measure on the nephrometry score systems: PADUA, RENAL, C-index. The average sum of balls according to scale RENAL – 7.56 ± 1.12, on scale PADUA – 7.98 ± 1.55, on scale C-index – 2.76 ± 1.14. Then in retrospect by the method of logistic regression analysis was determined predictive value of RENAL, PADUA, C-index nephrometry score systems for prediction of warm ischaemic time, duration of operative measure, extent of intraoperative blood loss and possibility of rate of postoperative complications.

Results. In 265 (84.4) cases transperitoneal approach was perfomed and in 49 (15.6 %) cases it was retroperitoneal approach. The average time of laparoscopic partial nephrectomy is 140.15 ± 55.8 min, the average time of ischaemic warm is 13.35 ± 7,65 min. The average extent of blood loss during the laparoscopic partial nephrectomy is 291.95 ± 196.5 ml. Intraoperative complications were found in 8 (2.54 %) cases. Postoperative complications were estimated according to the Clavien–Dindo classification of surgical complications and were found in 31  (9.9 %) cases, among them 12 (3.8 %) patients had surgical complications. The index of the RENAL nephrometry scoring system had the highest predictive value in the multivariant analysis for warm ischaemic time, extent of intraoperative blood loss and possibility of development after complications (p = 0.049; 0.028; 0.046). None of indices were significant for multivariant analysis of prognosis the duration of laparoscopic partial nephrectomy. The indices  of the RENAL (p = 0.032) and C-index (p = 0.040) nephrometry score systems were significant for univariate analysis of prognosis the duration of the laparoscopic partial nephrectomy.

Conclusion. The usage of RENAL, PADUA, C-index nephrometry score systems is useful for the prediction of warm ischaemic time, extent  of blood loss, duration of operative measure and possibility of rate of postoperative complications at laparoscopic partial nephrectomy. According to our data the index of RENAL nephrometry scoring system has the highest predictive value. Applications of 3D modelling for counting nephrometry indices in preoperative period makes the process of counting balls easier on all three nephrometry score systems.

Renal cancer morbidity grows in most of the developed countries. Incidence of bilateral renal cell carcinoma, per various authors, amounts  to 2–6 % of all cases of this disease. The study included 160 patients with bilateral kidney cancer who received surgical treatment  at the N.N. Blokhin National Medical Research Center of Oncology in the period from 1996 to 2014. Median follow-up duration for all patients included in the analysis was 81.05 ± 46.7 months. In our study, the groups for synchronous and metachronous cancer were equal (n = 80) and constituted 3.5 % of all cases of kidney cancer. For synchronous and metachronous cancer types, the most common concomitant disease was arterial hypertension. The most common morphological variant for the first, as well as the second, kidney tumor was clear cell carcinoma. Smoking and ischemic heart disease as a concomitant pathology negatively affected relapse-free and overall survival. Overall 5-year survival for synchronous renal cancer was 84.4 ± 4.2 %, for metachronous – 64.8 ± 9.3 %.

Background. The general characteristic of renal cell cancer is metastatic invasion of tumor thrombus in the inferior vena cava (IVC). Objective is the evaluation of the results of surgical treatment of patients with renal cell carcinoma and venous tumor thrombus.

Materials and methods. During the period from 2011 to April 2017  in the Clinic of Urology at the N.I. Pirogov City Clinical Hospital No. 1 26  radical/cytoreductive nephrectomies with thrombectomy were conducted. Men predominated (n = 20 (76.9 %)) over women (n = 6 (23.1 %)) among the patients. Median age – 64 years (47–82 years). 14 (53.8 %) patients were diagnosed with disease of the right kidney and 12 (46.2 %) of the left kidney. Level I (n = 12 (46.2 %)) – renal vein, perirenal part of the IVC. Level II (n = 8 (30.8 %)) – infrahepatic part of the IVC. Level III (n = 5 (19.2 %)) – retrohepatic part of the IVC. Level IV (n = 1 (3.8 %)) – supradiaphragmatic (intrapericardial, intra-atrial) part of the IVC. Enlarged retroperitoneal lymph nodes were detected in 11 (42.3 %) cases based on the data received from computed tomography scan. 6 (23.1 %) patients were diagnosed with distant metastases at the time of operation: solitary in 4 (15.4 %) cases, multiple in 2 (7.7 %) cases.

Results. All interventions ocurred without intraoperative lethality. Median operative time – 212 minutes (140–335 minutes). Blood loss median 300 ml (50–5000 ml). Blood salvage (Cell-Saver) was used on 4 (15.4 %) patients due to major blood loss. In 4 (15.4 %) cases one of single-plane operations was performed (cholecystectomy, atypical hepatic resection, prosthetic repair of abdominal region of aorta, resection of the IV liver segment, left hemicolectomy (T4, malignant invasion in descending colon)). Postoperative complications were registered  in 8 (30.8 %) cases. Lethality in the early (30 days) postoperative period equaled 7.7 % (n = 2).

Conclusion. Radical/cytoreductive nephrectomies with thrombectomy from the IVC is a technically complex surgery. It should be performed in expert centers with material and technical resources for such operations.

Background. Kidney damage caused by long warm ischemic time is one of the most important factors affecting kidney function. Compression of only the segmental artery leading to the tumor is an alternative to total ischemia. Оbjective: to evaluate the effectiveness of laparoscopic partial nephrectomy (LPN) with selective kidney ischemia.

Materials and methods. The results of laparoscopic partial nephrectomy in 68 patients with Т1а (n = 60) and Т1b (n = 8) disease stages and a healthy contralateral kidney were analyzed. Patients with tumors of the solitary kidney weren’t included. The study included 38 (55.9 %) men and 30 (44.1 %) women. Mean age was 58.4 ± 7.8 years. In 36 (52.9 %) patients LPN was performed with compression of the main renal artery (1st group), in 32 (47.1 %) patients the segmental artery was clipped (2^nd group). Mean tumor size in the 1st group was 3.6 ± 1.5 cm (2.5–5.8 cm), in the 2^nd group – 3.2 ± 1.2 cm (2.3–5.2 cm). Surgery duration, warm ischemia time, blood loss volume, and glomerular filtration rate prior to surgical intervention and after it were studies.

Results. All LPNs were concluded with laparoscopic access. There were no conversions to open surgery and nephrectomy. However, in 5  of 32 patients in the 2^nd group, the second branch of the renal artery was compressed due to large blood loss after clipping of one small artery. Surgery duration in the 1^st group was 90.0 ± 18.6 min (65–120 min), in the 2^nd group – 100.0 ± 22.0 min (70–135 min) (р >0.05). Warm ischemia time in the 1st group was significantly lower (16.0 ± 4.2 min versus 22.0 ± 4.6 min). Blood loss volume in the 1st group was 160.0 ± 80.6 ml, in the 2^nd group – 240 ± 160 ml. Glomerular filtration rate before the surgery was 42.4 ± 4.2 ml/min in the 1st group and 42.6 ± 4.2 ml/min in the 2^nd group; 3 months after the surgical intervention, it was 30.6 ± 3.4 and 35.8 ± 3.6 ml/min, respectively (р <0.05).

Conclusion. LPN with compression of the segmental artery directly supplying the tumor prevents ischemia of the whole parenchyma and significant loss of its function in the postoperative period.

Objective: a preliminary assessment of safety, tolerability, and efficacy of lenvatinib in combination with everolimus in unselected patients with metastatic renal cell carcinoma (mRCC) resistant to antiangiogenic targeted therapy.

Materials and methods. We analyzed medical data of 19 consecutive mRCC patients received lenvatinib in combination with everolimus following antiangiogenic targeted therapy failure. Median age was 55 (23–73) years. ECOG PS 0–1 was in 11 (57.9 %), ECOG 2–4 – in 8 (42.1 %) cases. Four (21.1 %) patients were distributed into the good, 10 (52.6 %) – into the intermediate, and 5 (26.3 %) – into the poor IMDC (International Metastatic Renal Cancer Database Consortium) prognostic group. Multiple metastases were diagnosed in 18 (94.7 %), multiple metastatic sites – in 17 (89.5 %), liver metastases – in 6 (37.6 %) cases. All the patients were previously treated with 1–4 lines  of therapy (≥2 – 12 (63.1 %)). Median follow-up was 5 (2–10) months.

Results. By the time of the analysis 12 (63.2 %) patients are being treated, 7 (36.8 %) – completed combined treatment (due to RCC progression – 4 (21.1 %), toxicity – 2 (10.5 %), death from unrelated reason – 1 (5.3 %)). Median time of completed therapy was not reached, mean treatment time was 5.1 (1.9–11.2) months. Adverse events were registered in 17 (89.5 %) patients (grade III – 3 (15.8 %), grade IV – 0, grade V – 1 (5.3 %)). The most common adverse events were diarrhea (68.4 %), stomatitis (57.9 %), hypertension (42.1 %), and weight loss (47.4 %). Lenvatinib or everolimus dose reduction was demanded in 5 (26.3 %) and 0, therapy interruption – in 5 (26.3 %) and 1 (5.3 %) patient respectively. Maximal response was assessed as partial in 1 (5.3 %) and stabilization – in 18 (94.7 %) cases. Decline of metastases size was registered in 12 (63.2 %) (median – 17 % (3–40 %)), stabilization – in 8 (42.1 %), enlargement – in 1 (5.3 %) patient. Median time to maximal response was 2 (2–4) months. Five-months overall and progression-free survival rates were 76.1 and 87.4 % respectively. Following 2 cycles of combined therapy ECOG PS improved in 11 (57.9 %), stabilized – in 6 (31.6 %), worsened – in 2 (10.5 %) patients.

Conclusion. Our preliminary data have confirmed antitumor activity and showed acceptable tolerability of lenvatinib in combination with everolimus in unselected patients with mRCC resistant to antiangiogenic targeted therapy.

Background. Lymph node metastases in prostate cancer (PC) are a negative prognostic factor. Non-invasive methods for their diagnostics are of primary importance. Objectives are identification of miRNA markers of lymph node metastases in plasma of PC patients and investigation of changes in primary tumors transcriptomes and plasma miRNA profiles during metastasis.

Materials and methods. Plasma of 20 PC patients (10 with pN0M0 and 10 with pN1M0 stage) were collected and plasma miRNA expression was profiled on GeneChip miRNA 4.0 arrays (Affymetrix, USA). Target genes were searched for miRNAs with significant expression difference between pN0M0 and pN1M0 groups (fold change ≥2; p <0,05). In addition, bioinformatic analysis of 392 PC primary tumors transcriptomes from PRAD collection (ТCGA Research Network: http://cancergenome.nih.gov/) was done (318 for pN0M0 stage and 74 for pN1M0 stage).

Results. The level of 17 miRNAs were significantly lower in plasma of pN1M0 group. Analysis of primary tumors expression profiles revealed 88 genes with significantly different expression between pN0M0 and pN1M0 groups (fold change ≥1,5; p <0,05). 11 of these genes are the potential targets of 17 miRNAs with lower levels in plasma of pN1M0 group. Interestingly, in most cases (8 out of 11) expression of these genes in primary tumor is elevated.

Conclusion. The level of 17 miRNAs were significantly lower in plasma of PC patients with lymph nodes metastases (pN1M0). Analysis  of primary tumor transcriptomes revealed a possible connection between miRNAs and their target genes levels in primary tumor and plasma. 17 plasma miRNAs found in this work could be a novel non-invasive markers of lymph nodes metastases in PC.

Brachytherapy is one of the methods of radiotherapy allowing to deliver a highly effective radiation dose to a tumor through a minimally invasive intervention. Depending on the source, brachytherapy can be low- and high-energy. The article describes the main stages of development of prostate cancer brachytherapy both in Russia and abroad. The main methods of brachytherapy used in modern medicine are described. References to recommendations of the leading radiological organizations on low-energy brachytherapy are provided. The main indications and counterindications for brachytherapy for treatment of prostate cancer using low-energy sources are described. Summary data on the effectiveness of the method depending on prostate cancer prognosis are presented. The results of using low-energy brachytherapy at the branches of the National Medical Research Center of Radiology of the Ministry of Health of Russia are described.

Objective: to evaluate the effectiveness of salvage radiotherapy in patients with recurrent prostate cancer after radical prostatectomy.

Materials and methods. In the period from March 2009 to January 2015, 92 patients with prostate cancer and biochemical recurrences after radical prostatectomy underwent salvage radiotherapy with classic fractionation and hypofractionation of the radiation dose.

Results and conclusion. Median follow-up duration was 40 months (12–78 months). Overall survival was 100 %. Local control was 100 %. One (1), 2, and 3-year disease-free survival in the whole patient group was 96, 91, and 86 %; in the hypofractionation group it was 98, 95, and 89 %; in the classical fractionation group it was 95, 87, and 84 %, respectively. We have determined that the period of doubling of prostate-specific antigen level of ≤6 months (p = 0.035) after surgical treatment and prostate-specific antigen level >0.5 ng/ml (p = 0.037) at the time of salvage radiotherapy are significantly associated with worse prognosis for treatment effectiveness. There weren’t any differences in late toxicity between the 2 patient groups.

Prostate cancer (PC) is one of the most common causes of death from malignant neoplasms in men in many countries around the world. Transmission of the signal in the androgenic axis of regulation is crucial for the development and progression of PC. Despite the constant dependence on androgen receptor signals in castration resistance, the use of new anti-androgenic drugs invariably leads to the stability  of the ongoing treatment. The interaction of androgen receptor and alternative (phosphoinositide-3-kinases, PI3K) pathways in the regulation of cells can be one of the mechanisms of resistance to treatment. In this article, we describe current treatments for metastatic castration-resistant PC and the possible role of the PI3K pathway in the pathogenesis and progression of PC.

Background. Enzalutamide, an androgen receptor inhibitor that blocks multiple steps in the androgen receptor signaling pathway, is approved for patients with metastatic castration-resistant prostate cancer (CRPC). Since the phase III (AFFIRM) pivotal trial did not include Russia patients, this phase II study (NCT02124668) was performed to establish the safety of enzalutamide in patients with progressive CRPC previously treated with docetaxel-based chemotherapy in the Eastern European patients population, including the Russia.

Objective: to study safety of enzalutamide in patients with progressive CRPC previously treated with docetaxel-based chemotherapy from Eastern European, including the Russia.

Materials and methods. This phase II, multicenter, single-arm, open-label study was conducted at 2 sites in Russia and 2 sites in Georgia. Patients had on going androgen deprivation therapy with a gonadotropin-releasing hormone analogue (agonist or antagonist) or had a prior surgical or chiectomy. Patients completed visits on day 1, week 5, week 13 and subsequently every 12 weeks until they were discontinued from the study. The safety of enzalutamide was assessed through evaluations of adverse events (AEs), serious AEs, blood pressure, heart rate, electrocardiography and laboratory measurements.

Results. Thirty patients were enrolled and received enzalutamide treatment (mean age 67.5 years (59–80 years)). Median treatment duration was 271 days (3–968 days). By the end of the study, a total of 23 (76.7 %) patients experienced 68 treatment-emergent AEs (TEAEs). The most frequently reported TEAEs (reported in ≥10 % of patients) were fatigue (n = 7 (23.3 %)), asthenia (n = 6 (20.0 %)), bone pain, metastatic pain, prostatic specific antigen increase from baseline (n = 4 (13.3 %) each) and malignant neoplasm progression (n = 3 (10.0 %)). Most TEAEs were Grade 1 or Grade 2 in severity (35 and 14 events respectively, of a total of 68 AEs). The most frequently reported Grade 3 or higher TEAEs were asthenia (n = 5 (16.7 %)) and bone pain (n = 3 (10.0 %)). Enzalutamide-related TEAEs were experienced by 7 (23.3 %) patients and consisted of the following: fatigue in 3 patients; asthenia in 2 patients; and supraventricular extrasystoles, dizziness, headache, insomnia, pollakiuria and alopecia in 1 patient, each. Six (20.0 %) patients experienced 13 serious TEAEs. The most common serious TEAE was malignant neoplasm progression (n = 3 (1 %)) due to disease progression; all others were single events. Three (10.0 %) patients had died due to serious TEAEs that occurred during the study (2 of prostate cancer progression and 1 of cardiopulmonary and liver failure). No patients experienced an enzalutamide-related Grade 3 or higher TEAEs, an enzalutamide-related serious AEs or an enzalutamide-related TEAEs leading to permanent discontinuation. No notable changes from baseline in clinical laboratory parameters or clinically meaningful abnormalities in vital signs, physical examinations, or electrocardiography were found. No cases of seizures were reported.

Conclusion. In this study, enzalutamide in the Eastern European patient population, including the Russia, had a safety profile consistent with that reported in previous enzalutamide studies and no new safety signals were observed.

Objective: to determine clinical and economic consequences of using the degarelix drug instead of gonadotropin-releasing hormone (GnRH) analogs for treatment of advanced hormone-sensitive prostate c ancer.

Materials and methods. The main criteria of therapy effectiveness were overall survival and progression-free survival. Cost of the drugs being compared, as well as expenses associated with therapy after prostate cancer progression (per the dynamics of plasma prostate-specific antigen levels), were considered. A Markov model of prostate cancer progression was used including states “without progression”, “after progression”, and “death”. The modeling time horizon was 3 years. The main source of information on drug costs was the registry of maximal retail pricese for vital and essential drugs. The target population only included patients with high (>20 ng/ml) baseline level of prostate-specific antigen. Information on effectiveness was obtained based on analysis of the results of randomized comparative clinical trials of degarelix and leuprorelin.

Results. Compared to leuprorelin, degarelix use was characterized by more favorable effectiveness and safety profiles (based on all criteria considered in the analysis). In the basic modeling script, progression-free survival was 27.9 and 20.1 months for degarelix and GnRH agonists, respectively. Despite higher cost of therapy prior to progression (359,000 and 268,000 rubles, respectively), degarelix use instead of GnRH agonists leads to 31 % decrease in direct budget medical expenses on drug provision under the state guarantee program (1,322,000 vs. 1,907,000 rubles), as well as to a decrease in the cost-effectiveness ratio (47,408 rubles/month without prostate cancer progression versus 94,651 rubles/ month without prostate cancer progression)

Conclusion. Compared to treatment with GnRH agonists, use of degarelix as the 1st line therapy for treatment of prostate cancer leads to significant savings of healthcare budget expenses.

Background. Radical cystectomy remains the golden standard for treatment of muscle invasive bladder cancer. Objective: to duplicate with highest accuracy the open radical cystectomy procedure, which we successfully utilized earlier in our clinic, in the of laparoscopic conditions in order to preserve the advantages of minimally invasive procedures and retain the reliability of the tried and tested open surgery.

Materials and methods. In the report were included 35 patients (27 men and 8 women) with bladder cancer, who underwent laparoscopic radical cystectomy in Volgograd Regional Center of Urology and Nephrology between April 2013 and March 2016. Only the patients who had been submitted to full intracorporal ileal conduits were included.

Results. The mean operative time was 378 minutes, the mean blood loss was 285 millilitres, the mean length of hospital stay was 12.4 days, only 20 % of patients required the narcotic anesthetics. The postoperative complication rate was 11.4 %. However, the majority of the patients were successfully treated with minimally invasive procedures. Generally, our results were similar to other reported studies.

Conclusion. Laparoscopic radical cystectomy is a safe and efficient modality of treatment of bladder cancer. However, it needs more procedures and longer observation period to establish laparoscopic radical cystectomy as an alternative to open radical cystectomy.

Background. The high recurrence rate after conventional transurethral resection (cTUR) for bladder cancer (BC) requires search for more effective methods of surgical treatment. Objective: to evaluate the feasibility, safety, and efficacy of cTUR versus thulium laser en bloc resection of bladder tumors using new fiber laser “Urolaz”.

Materials and methods. 129 patients, who underwent surgical treatment for BC between 2015–2017 in urological department of I.M. Sechenov First Moscow State Medical University were included in the study. The cTUR were performed for 58 patients, 71 patients underwent thulium laser en bloc resection of bladder tumors.

Results. The presence of detrusor muscle in specimen was 58.62 % in cTUR group and 91.55 % in thulium laser en bloc resection group respectively. Obturator nerve reflex, bladder perforation, and bleeding in thulium laser en bloc resection group were absent, therefore immediate instillation of chemotherapy was made in all these cases. Recurrence rate after 12 and 18 months after surgery in the group of en bloc resection was statistically lower compared to the cTUR group.

Conclusion. The results, obtained in our study shows that thulium en bloc resection using thulium fiber laser “Urolaz” is feasible, effective and safe procedure for patients with BC. Thulium en bloc resection has a number of advantages over the cTUR: absence of obturator nerve reflex, high quality of specimen for pathological examination (presence of detrusor muscle in specimen was 91.55 %) and low recurrence rate.

Оbjective is to evaluate the rate of bladder cancer in children and adolescents, characteristics of its histological variant, and treatment approaches.

 Materials and methods. A review of international literature on the problem of bladder cancer in children and adolescents as well as our own clinical observations of this pathology in 7 male patients aged 5–17 years in the period from 2012 to 2017 are presented.

Results. According to the literature data and our own clinical observations, bladder cancer in children and adolescents is a rare pathology and it is a well-differentiated transitional cell carcinoma, localized, with favorable prognosis and rare recurrence. Treatment approach for bladder cancer in children and adolescents is the same as in adults, and usually is limited to transurethral resection of the bladder tumor.

Conclusion. These observations serve as a reminder that bladder cancer can occur in children and adolescents, as well as in adults, which should elevate oncological vigilance among general practitioners.

Treatment of bladder cancer has been a complicated problem. Low survival for regional and metastatic disease remains. In recent years,  the efforts of doctors, biologists, diagnosticians were aimed at development of new technologies in these spheres and improvement of treatment results for this pathology. In this review, current views on diagnosis, the role of repeated surgical interventions in non-muscle-invasive bladder cancer, etc. are presented. Advances in molecular biology allowed to differentiate subtypes of urothelial bladder cancer. Importantly, the results of biomolecular studies allowed to identify different responses to drug treatment. Moreover, in some cases these results have a follow-up period of up to 3 years. Based on other data characterizing the tumor, the effectiveness of new drugs for treatment of regional, metastatic and post-cisplatin therapy bladder cancer was evaluated. These results allow to hope for increased life span and quality of life for patients with this severe disease.

On January 1, 2018, an updated 8^th edition of the international TNM Classification of Malignant Tumors comes into effect. The classification was developed by 2 leading organizations: the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). Based on consensus conferences of the International Society for Urological Pathology (ISUP) which reconsidered the current approaches to pathomorphology and staging of malignant tumors of the prostate (2009), kidneys (2012), testicles and penis (2015), the World Health Organization approved the new morphological classification of tumors of the urinary and male reproductive systems. At the first time, the TNM Classification indicates evidence level.

In the last 20 years, a concept of using multimodal programs of early rehabilitation of patients after surgical interventions – Enhanced Recovery After Surgery (ERAS) – has been developed in medicine. In oncological urology, the ERAS protocol is used only in treatment of bladder cancer. At the same time, not all available elements of this program are used despite the fact that in Russia 24.4 % of malignant tumors are urogenital tumors, and bladder cancer comprises one sixth (4.6 %) of them. Frequently, reconstructive plastic surgery is an integral part of bladder cancer treatment, and it’s accompanied by various complications many of which are associated with incorrect tactics of perioperative patient care. This situation can be dramatically improved by a more widespread use of the ERAS protocol. The immediate problem  of oncological urology is development of an effective, safe, and available for wide use algorithm of postoperative rehabilitation of patients with malignant tumors of the bladder after cystectomy with cystoplasty.

Simultaneous surgeries in oncological pathology on the background of competing diseases of the cardiovascular system are the method  of choice. This article describes a clinical case of simultaneous interventions in a patient with coronary artery disease, mitral valve insufficiency and squamous cell carcinoma of the left kidney.