[Combined therapy for children and adolescents with Ewing tumors (a 25-year experience)].

A total of 115 children (median age 10.5 years, range 2-17) with Ewing sarcoma family tumors (ESFT) received therapy in N.N. Petrov Institute of Oncology pediatric department from April 1985 till August 2013. These patients were divided into two groups depending on treatment tactics used: patients treated according to modified T9 protocol (n = 64) and patients treated according to EICESS-92 or Euro-Ewing 99 regimens (n = 51). Twenty four patients from the second group with adverse prognostic factors received high-dose chemotherapy with autologous stem cell transplantation. All patients received surgical treatment and/or irradiation for primary tumor local control. Five-year overall and disease-free survival was 39% and 37,9% in the first group. In the second group these values were significantly higher; 55% and 39.5%, accordingly (p = 0.03 and 0.25). All patients from the first group with primary metastatic ESFT died of disease progression, while in the second group OS and DFS reached 45.8% and 28.9%, accordingly. There was a statistically significant correlation between local relapse rate and irradiation dose biological equivalent (in TDF units). The local relapse cumulative rate was minimal (12,6%) in patients receiving 80 TDF.

[Evaluation of ovarian status in women who received anti-tumor therapy in childhood and adolescence].

The paper presents the results of a study of the ovarian reserve in young women who received treatment for malignant tumors in childhood and adolescence and are in complete clinical remission. The function of the reproductive system was evaluated by serum concentrations of gonadotropins, estradiol, anti-Müllerian hormone (AMH) and inhibin B. The results were compared to the treatment, patients' age at the beginning of therapy and at the time of the examination. AMH level in serum was the most informative indicator of ovarian reserve in patients treated for malignant tumors.

[Treatment results in localized forms of reticulosarcoma and Ewing's sarcoma in children]. / Rezul'taty lecheniia lokalizovannykh form retikulosarkomy i sarkomy Iuinga u detei.

The results of treatment of 53 cases of pediatric localized Ewing's sarcoma and bone reticulosarcoma were analysed. Chemoradiotherapy is a procedure of choice in bone marrow sarcoma treatment: while overall five-year survival was 28.4 +/- 6.2%, it was as high as 64.9% in cases of combined treatment (total focal dose of at least 50 Gy + polychemotherapy). Two cases of osteo- and chondrosarcoma development in exposed bone are described.

[Pulmonitis and pulmonary fibrosis following radiotherapy of lymphogranulomatosis]. / Pul'monity i legochnye fibrozy posle luchevogo lecheniia limfogranulematoza.

Data on 314 cases of radiation and chemoradiation treatment for Hodgkin's disease were analysed. Pulmonitis was registered in 8.9 and paramediastinal fibrosis--in 37.6%. The incidence of pulmonitis did not vary with cumulative radiation effect (CRE) and time-dose-fraction (TDF) values computed for irradiation field area. A significant increase in the incidence of paramediastinal fibrosis was observed at CRE and TDF values exceeding 1,500 reu and 77 units, respectively. There was no relationship between the above pathology and treatment modality (60Co teletherapy and 25 MeV fast electrons).

[Combination chemotherapy with total or subtotal lymphatic irradiation in the treatment of lymphogranulomatosis, stage IIIA or IIIB (based on five- and ten-year results)]. / Kombinirovannaia khimioterapiia v sochetanii s total'nym ili subtotal'nym oblucheniem limfaticheskikh kollektorov v lechenii limfogranulematoza IIIA i IIIB stadii.

High rates of overall and recurrence-free 5- and 10-year survival were recorded in 561 patients with Hodgkin's disease (stage IIIA-IIIAE and IIIB-IIIBE) after combination therapy using 2-4 cycles of MOPP, MOPP/ABV, COPP, DOPP or DOPP/ABV polychemotherapy, with radiation treatment being reduced to subtotal irradiation of lymph collectors. Total 5- and 10-year survival for stage IIIA was 96.8 and 91.5 and recurrence-free survival-81.2 and 81.2%, respectively: for stage IIIB-90.7; 83.2 and 68.6; 56.6%, respectively.

[Clinical effect of radiotherapy in the treatment of non-Hodgkin's lymphoma in children]. / Klinicheskaia otsenka roli luchevoi terapii v lechenii nelimfoblastnykh nekhodzhkinskikh limfom u dete.

The results of combined treatment were analysed retrospectively in 85 children with nonlymphoblastic non-Hodgkin's lymphomas (NHL) of I-II-III stages (Ann Arbor). The importance of involved-field radiation therapy (IFRT) combined with ACOP, MEV, COP chemotherapy was assessed. All patients experienced high grade nonlymphoblastic subtypes of NHL as follows: follicular center cells, undifferentiated, immunoblastic (Lukes-Collins classification). Adjuvant IFRT resulted in significantly increased rate of 5-year overall and disease-free survival and diminished relapse frequency.

[Role of bone marrow scintigraphy in defining the therapeutic approach for some malignant tumors in children] . / Vklad rezul'tatov stsintigrafii kostnogo mozga v opredelenii lechebnoi taktiki pri nekotorykh zlokachestvennykh novoobrazovaniiakh u detei.

The data on scintigraphic examinations of the bone marrow (BM) carried out in 76 patients, aged 2-16, are evaluated. Focal, multi-focal and diffuse lesions were identified. Metastases to BM were detected in 6 out of 28 (21%) patients with Hodgkin's disease. Scintigraphic evidence played a role in working out treatment modalities in 4 cases. Metastatic foci located outside primary tumor were detected in 3 out of 26 (11.5%) patients with Ewing's sarcoma and scintigraphic findings were considered in all 3 cases when scope of radiotherapy and chemotherapy intensity were elaborated. Also, lesions to BM were found in 9 out of 22 (41%) patients with neuroblastoma. Radiotherapy was ruled out in 4 cases of multi-focal and diffuse lesions while all 5 patients with focal ones received it.

[Development of second tumors in patients with Hodgkin's disease (review of the literature and personal data)]. / Razvitie vtorykh opukholei u bol'nykh limfogranulematozom (obzor literatury i sobstvennye dannye).

The literature data and the authors' findings on second tumors in patients treated for Hodgkin's disease are analyzed. Most patients who subsequently developed acute leukemia and solid tumors received chemoradiation treatment, while only few of them were exposed to radiation alone. Acute leukemia and solid tumor development is attributed to application of alkylating drugs. Out of 420 patients under study, leukemia was registered in 2 and solid tumors--in 4 cases.

[Aseptic necrosis of the head of long tubular bones in patients with lymphogranulomatosis]. / Asepticheskii nekroz golovok dlinnykh trubchatykh kostei u bol'nykh limfogranulematozom.

The frequency of aseptic necrosis of femoral head was evaluated on the basis of 1066 case histories of Hodgkin's disease of all stages in patients aged 15 and more. The lesions were found in 14 patients (1.3%). Nine of them had received combined treatment for tumor, four--combination chemotherapy alone, and one--radiation alone. All had been given prednisolone. No significant correlation between treatment modality and osteonecrosis development was established. It is suggested that the effect of synergism of such damaging factors as ionizing irradiation, cytostatic drugs and glucocorticoids may be responsible for aseptic necrosis in cases of Hodgkin's disease.

[Comparative evaluation of the efficacy of chemotherapy and chemoradiotherapy of stage IIIB Hodgkin's disease]. / Sravnitel'naia otsenka éffektivnosti khimioterapii i khimioluchevogo lecheniia limfogranulematoza IIIB stadii.

The results of treatment of 92 cases of stage IIIB Hodgkin's disease were evaluated. Combined treatment (46) included 3-4 courses of MOPP (embichin, vincristine, natulan and prednisolone) followed by radical radiotherapy 2-4 weeks later. Complete remission was recorded in 36 (78.3%) out of 46 patients. Overall 5-year survival in that group was 75.3 +/- 7.8% matched by 95.8 +/- 4.2% in those in complete remission (36). No signs of recurrence were observed in 68.0 +/- 11.1% in the latter group during the 5 years of follow-up. Combination chemotherapy (MOPP) alone was given to 46 patients. Complete remission was registered in 43.5% of those patients which was significantly less frequent than in the combined therapy group (78.3%). Overall 5-year survival was 53.8 +/- 8.6% and recurrence-free course--in 58.1 +/- 11.7%. Overall survival and complete remission rate in the combined treatment group were shown to be significantly higher than in the patients who had received 5-6 courses of MOPP alone.

[The role of radiotherapy in the treatment of Stage IIIA Hodgkin's disease in children]. / Rol' luchevoi terapii v lechenii limfogranulematoza IIIA stadii u detei.

The report discusses the results of treatment of 54 patients (aged 2-14) with stage IIIA Hodgkin's disease. Radiotherapy was followed by relapse-free period in 60.6% only, although 5-year survival rate was rather high (90.9%). In the chemoradiation treatment group the said rates were 92.3 and 100%, respectively.

[Comparative evaluation of surgical and combined treatment of cancer of the proximal region of the stomach]. / Sravnitel'naia otsenka khirurgicheskogo i kombinirovannogo lecheniia raka proksimal'nogo otdela zheludka.

The paper deals with an analysis of the results of treatment of 351 cases of radical surgery for cancer of the proximal part of the stomach (surgery-303, surgery + preoperative large-fractionated radiation-48). It was found that radiation was not followed by increased blood loss during operation nor did it interfere with application of any surgical procedure. Concentrated irradiation did not involve an increment in postoperative lethality and complication rates. Five-year survival rates were 37.4 +/- 8.0 in cases of combined treatment and 20.4 +/- 2.7% in those of surgery. The improvement in survival rates recorded in cases of combined treatment was largely due to a decreased incidence of local recurrences.

[Clinical experience with the use of mantle-like and large-field irradiation associated with polychemotherapy in lymphogranulomatosis]. / Klinicheskii opyt primeneniia mantievidnogo i krupnopolnogo oblucheniia v sochetanii s polikhimioterapiei pri limfogranulematoze.

The data of dosimetry are reported as well as the technic of irradiation of patients with lymphogranulomatosis by 60Co gamma-quanta after the schedule involving large size figure fields on the national gamma-therapeutic machine "Rokus". Thirty two patients with the disease in stage I--III have been treated. It is shown that patients quite satisfactory undergo irradiation after a large-field variant of radical radiation therapy which, if necessary, may be associated with polychemotherapy according to MOPP schedule.

[Malignant non-Hodgkin lymphoma in children: factors of prognosis and results of therapy]. / Zlokachestvennye nehodzhkinskie limfomy u detei: faktory prognoza i rezul'taty lecheniia.

The analysis included 187 cases of infantile non-Hodgkin's disease. It has identified Ann Arbor System stage and histological pattern of tumor (Lukes-Collins and Kiel) as a reliable and significant factor of prognosis.

[Comprehensive therapy of localized bone marrow sarcoma in children]. / Kompleksnoe lechenie lokalizovannykh kostnomozgovykh sarcom u detei.

The retrospective analysis included the results of the treatment of 67 children suffering from localized sarcomas of bone (Ewing's sarcoma, lymphosarcoma). The advantage was demonstrated in patients, received combination of chemotherapy and radiotherapy on the involved bone. The resection of the primary tumor in combination with radio-chemotherapy improves the 10-year survival.

[Clinical evaluation of efficacy of chemoradiotherapy for Hodgkin's disease]. / Klinicheskaia otsenka éffektivnosti khimioluchevogo lecheniia limfomy Khodzhkina III (A,B) stadii.

Patients with stage III (A,B) Hodgkin's disease (366) received chemoradiotherapy consisting of 2-4 courses of combined modality treatment followed by total or subtotal irradiation of lymph nodes. Overall 10-year (84%) and 15-year (79%) and relapse-free 10-year (85%) and 15-year (82%) survival was reported in stage IIIA cases. Subtotal exposure proved relatively more effective in such patients without iliac and inguinal lymph node involvement. If, following combined modality therapy, intoxication symptoms were aborted in stage IIIB patients; fairly good results were obtained after total and subtotal irradiation of lymph nodes or involved areas (10-year (70%) and 15-year (65%) overall and 10-year (75%) and 15-year (75%) relapse-free survival.

[Progress and perspectives in pediatric oncology: 30-year experience of the clinic of pediatric oncology]. / Dostizheniia i perspektivy v onkopediatrii: 30 let raboty otdeleniia detskoi onkologii i gematologii.

Seventy percent of cases of Hodgkin's disease and 65% of those with kidney malignancies can be cured due to application of modern procedures of oncopediatrics. More intensive modalities have to be used for treatment of generalized forms of non-Hodgkin's lymphoma and sarcoma of Ewing. The rates of 3-year survival have risen to 70% in patients suffering acute leukemia following introduction of the new Protocol procedures. Infantile mortality from malignancies has been halved for the past 5 years (from 8.2/100,000 to 4.2/100,000) thanks to the taking of said measures and restructuring the oncopediatric service.

[Evolution of diagnostic and therapeutic methods in childhood Hodgkin's disease]. / Evolutsiia metodov diagnostiki i lecheniia limfogranulematoza u detei.

A retrospective analysis of the results of treatment of 467 cases of primary Hodgkin's disease (aged under 15) (1968-1992) has been undertaken. As such invasive diagnostic procedures as lower direct lymphography and laparotomy with splenectomy were being abandoned, polychemotherapy plus irradiation of zones of involvement alone at all stages were introduced. Although generalized forms of tumor (stage III-IV tumors in 69% of cases) were in evidence and risk-adapted therapy procedures were used, the 5-year survival for 1988-1992 was 88%, the recurrence-free survival rate in the treated cases being 67%.

[Results of therapy for osteogenic sarcoma in children: perspectives of improvement]. / Rezul'taty lecheniia osteogennoi sarkomy u detei: perspektivy uluchsheniia.

A retrospective analysis of treatment of 67 children suffering localized osteogenic sarcoma received at the Institute's Clinic (1977-1995) has been carried out. The best 5-year survival results were obtained with the COSS-91 and PECOSS programs and those for pre- and post-operative COMBAP chemotherapy (77.8 and 70.0%, respectively). Another randomized comparative study of the effectiveness of different polychemotherapy and pre-operative radiation schedules are being planned.

[Concentrated irradiation as a stage of multimodal treatment of cancer of the proximal part of the stomach]. / Kontsentrirovannoe obluchenie kak étap kombinirovannogo lecheniia raka proksimal'nogo otdela zheludka.

The postradiation changes in carcinoma of the proximal part of the stomach were studied in 32 patients: the parenchymal volume (PV), the damage index (DI), and the mitotic index (MI). The controls were 15 cases in which radiotherapy was not applied. Radiotherapy with large fractions (5 Gy 4 times daily) reduced the PV to 27 +/- 0.8 u on average as compared to the controls (77 +/- 1 u) and lowered the MI to 2.3 +/- 0.5% as compared to the controls (8% +/- 1), the DI ranged widely (3-67%). The methods of quantitative morphological study of tumors may be useful in objective evaluation of the efficacy of various schemes of preoperative concentrated irradiation.