Nephroblastoma (NB), or Wilms tumor, is one of the most incident and best studied malignant tumor of childhood. SIOP data on evolution of NB therapy in children for a more than 30-year period are discussed. Modern clinical classification of NB by the TNM/p/TNM system is presented. Basic principles of therapy of local and disseminated forms of the disease and remote results of NB treatment are presented.

The authors analyze the immediate results of 8 simultaneous operations, 4 of these under conditions of artificial circulation, in patients with renal cell carcinoma concomitant with heart diseases.
The immediate results were satisfactory, with good functional parameters. Due to simultaneous operations the incidence of intra- and postoperative cardiovascular complications is reduced, the progress of the tumor process between different stages of treatment is arrested, early radical interventions for tumor removal becomes possible, and the hospitalization period is shorter in comparison with staged operations.

Main surgical methods used for the treatment of pathological fractures of long tubular bones in patients with renal cancer metastases are discussed. Russian and foreign data on the problems of modern onco-orthopaedics are presented. Experience gained at N.N. Blokhin Oncological Research Center is presented and clinical examples of surgical treatment for renal cancer metastases in long tubular bones are described.

Surgery is the only effective method for the treatment of localized renal cell carcinoma (RCC). Today nephron sparing surgery (NSS) cures the majority of patients with early stage disease. Open radical nephrectomy (RN) is performed mainly in patients with large tumors and in cases complicated by the tumor thrombus extension into the vena cava. Laparoscopy is now more and more often used for RCC treatment. Laparoscopic RN (LRN) is now recommended for the treatment of early stage RCC, when NSS cannot be used. LRN seems to provide longterm cancer control comparable to open RN. RCC is now often diagnosed when the tumors are still small and can be often cured by NSS providing excellent local cancer control. Tumor size, location, multiple foci, surgical margin, and pathological variants are significant for cancer outcome in selective NSS. Laparoscopic partial nephrectomy (LPN) is now gaining popularity as an effective minimally invasive treatment in patients with relatively small and peripheral renal tumors. Recently minimally invasive ablative techniques were introduced for the treatment of RCC. These methods involve little complications if used for the treatment of small renal tumors. The currently used best therapy for metastatic RCC is inadequate and surgery is an important component of combined treatment including immunochemotherapy. Combinations of interferon-alpha, interleukin-2, and 5-fluorouracyl are now used for the treatment of metastatic RCC. Nephrectomy can be recommended for patients with good performance status before immunotherapy. Modern research is focused on identification of novel agents and treatment modalities with better antitumor activity.

Based on studies of a wide spectrum of physicochemical parameters of the blood in 160 patients with vesical cancer, the authors created complexes of informative tests and formulated the decision rules fit for evaluating the degree of tumor invasion before therapy. The diagnostic efficiency of this approach amounts to 87.5—89%.

Aim — improving the results of cystectomy by retaining the prostate and seminal vesicles.
87 cystectomies with restoration of urination and sparing the prostate with or without seminal vesicles were carried out in patients with vesical cancer in 1991—2005. Patients' ages varied from 33 to 75 years (mean age 56.1 years). The following modifications were performed: transprostatic cystovesiculectomy (11 pts), transprostatic and supraprostatic cystectomy (53 and 23 pts, respectively). The absence of prostatic cancer and negative data of urgent histological study of the resection margin were indications for reducing the standard volume of surgery.
Postoperative mortality was 2.3%. Mean period of observation was 60.8 months. Local relapses were diagnosed in 2.5%, remote metastases in 12.9% patients. Day-time continence was attained in 100%, nocturnal in 96.4% patients. Erectile function was retained in 79.6% patients. Cystectomy within normal tissues sparing the prostate and seminal vesicles helps preserve the optimally possible preoperative functional status without deteriorating oncological results.

Hormone resistant phase of prostatic cancer develops after 16-24 months of hormone therapy of metastatic prostatic cancer. Radiopharmaceutical method of treatment is essential for pain control in multiple metastases in the bones; we mean the use of beta-emission isotope strontium-89 chloride (metastrone). Total systems radiotherapy by strontium-89 chloride was carried out as stage III of multiple modality treatment in 90 patients with metastatic hormone-resistant prostatic cancer (HRPC) within the framework of randomized study. Before radiopharmaceutical therapy 18% patients complained of pronounced pain syndrome, 50% presented with moderate pain syndrome, and pathological fractures were diagnosed in 12% patients. Therapy with strontium-89 chloride led to stabilization of the pain syndrome during therapy in 72.7% and to its progress in 27.3% patients. This therapy was well tolerated in general. It can be used as a stage in combined treatment of HRPC patients.

Increased incidence of radical prostatectomies in the treatment of patients with prostatic cancer (PC) necessitates analysis of causes of the disease relapses after surgery. Positive surgical margin (PSM) is considered as one of the main causes.
Aim — study of the incidence of PSM in patients with a history of retropubic radical prostatectomy for clinically local and locally disseminated PC and evaluation of prognostic factors.
The incidence of PSM was analyzed in 271 patients with a history of retropubic prostatectomy, with consideration for the preoperative level of PSA, tumor differentiation and dissemination; the efficiency of neoadjuvant therapy (NAT) for PSM reduction was evaluated.
PSM was detected in 84 (31.0%) patients. Significant criteria for PSM prognosis are clinical stage of disease, Glisson sum, and relative number of positive biopsy columns. NAT significantly reduced the incidence of PSM only in patients with local PC.
NAT is indicated for patients with clinical signs of extraprostatic extension. It is ineffective in patients with locally disseminated PC because it cannot change the incidence of PSM.

Aim —to evaluate the clinical efficiency of strontium-89 chloride in the treatment of pain syndrome in patients with prostatic cancer (PC) with metastases in the bones.
99 patients with PC metastases to the bones were examined. Analgesic and antitumor effects of strontium-89 chloride were evaluated.
Analgesic effect was noted in 73% of patients with hormone-resistant PC and 92% of patients receiving hormone therapy and biphosphonates, in whom the drug effect did not depend on the extent of tumor involvement. No effect was observed mainly in the patients with lytic lesions. Strontium-89 chloride contributes to bone tissue repair.

Strontium-89 chloride is an effective analgesic for patients with PC metastases in the bones. It can be used in complex with other treatments, promoting bone repair in some cases.

The results of interactive voting on the problem of therapeutic strategy in different stages of prostatic cancer are summed up. The voting was carried out at the VIth All-Russian Conference "Pressing Problems in Oncourological Diseases". Based on the results of priority studies and metanalyses, the authors discuss a wide spectrum of disputable problems concerning the indications for radical surgery, hormone and symptomatic treatment of the disease.