Brachytherapy (BT) is a method of radiation therapy with radioactive source contacting the tumor. It was proposed by P. Moore and H. Stallard in 1929. Despite those 50 years of experience with the use of BT in ophthalmic oncology, there are only a few studies on the use of Ru-106 BT for retinoblastoma (RB), and no publications on the use of Sr-90 BT have been found. Purpose . To present our own experience with the use of ruthenium and strontium ophthalmic applicators for BT in retinoblastoma. Materials and methods . 120 patients (137 eyes and 194 RB foci) received BT as a local treatment in the period from 2007 to 2020. At the time of treatment the age of the patients varied from 4 to 109 months (mean age 26 months). In 32 % of cases (44 eyes) there were monofocal lesions, and in 68 % of cases (93 eyes) — multifocal. In 36 cases (30 %) BT was performed in the single eye. 79 patients (87 eyes) were treated with the use of ruthenium ophthalmic applicators (OAs), 25 patients (26 eyes) — with the use of strontium OAs, and for the treatment of 16 patients (24 eyes) both ruthenium and strontium OAs were used. Results . Clinically complete tumor regression was achieved in 62 % of cases (120 foci), partial tumor regression — in 31 % of cases (60 foci). In 6 % of cases (12 foci) continuous tumor growth was observed, and tumor recurrence occurred in 1 % of cases (2 foci) within 4 to 6 months after BT. Local tumor control was achieved in 93 % of cases. The single eyes were preserved in 92 % of cases. BT complications of different intensity were reported in 38 % of cases (46 patients — 49 eyes) with the mean follow-up duration of 55 months (3 to 157 months). In 92 % of cases (42 patients — 45 eyes) complications were associated with the use of ruthenium OAs, and only in 8 % of cases (4 patients — 4 eyes) — with the use of strontium OAs. Risk factors for radiation-induced complications were identified: focus size (height more than 2.5 mm [Р = 0.0005], extension more than 7.3 mm [Р < 0,0001]), sclera dose more than 626 Gr (Р = 0,0002), and the central localization of the tumor (Р < 0.0001). Conclusions . Ruthenium-106 and strontium-90 brachytherapy is a highly effective treatment modality for the management of RB.

Relevance. The success of treatment of children with hepatoblastoma (HB) is associated primarily with the optimization of diagnostic and therapeutic strategies. The introduction of a system of therapeutic definition of a risk group developed by the International Society for the Study of Liver Tumors in Children’s Hepatic tumors International Collaboration (CHIC) in patients with HB allows for effective risk stratification. Patients of the very low-risk group have a favorable prognosis and, unlike patients of other groups, they can perform surgery at the 1st stage, and children from the very low-risk group with a “pure” fetal version of the morphological structure of the tumor can be cured without chemotherapy – only by surgical method. This article presents an analysis of a series of observations of children with HB very low-risk. Methods and patients. A retrospective analysis of the data of 138 patients who received treatment at the Research Institute of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Centre of Oncology of the Ministry of Health of Russia from January 2006 to February 2018, all patients underwent examination in the following volume: computed tomography (CT) of the chest, ultrasound of the abdominal cavity and retroperitoneal space, CT and/or magnetic resonance imaging of the abdominal cavity with contrast enhancement. Serum levels of human chorionic gonadotropin and alpha-fetoprotein (AFP) were measured. The prevalence of tumor lesions was retrospectively evaluated using the PRETEXT system (Pre-Treatment Extent of Disease, assessment of the prevalence of the tumor process before treatment, 2017 version). Based on the data obtained, 18 (13 %) patients with hypertension were identified in the very low-risk group using the CHIC stratification system. Of 18 (100 %) patients of the very low-risk group, 8 (44.4 %) received therapy in the interval from January 2006 to October 2010 according to the treatment protocols of the SIOPEL group. The treatment included a combination of neoadjuvant chemotherapy with delayed surgery and adjuvant chemotherapy. Since November 2010, the Research Institute of Pediatric Oncology and Hematology adopted a protocol for the treatment of children with hypertension, suggesting the possibility of performing surgical treatment at the 1 st stage in patients with a localized stage of the disease with the spread of PRETEXT I/II. From December 2010 to November 2018, 10 (55.6 %) patients from the very low-risk group were operated on at the 1 st stage. A tumor biopsy was not performed before the intervention. After a histological examination, 4 (22.2 %) patients had an epithelial variant of the structure of HB that did not meet the criteria of a “pure” fetal variant. He was given adjuvant chemotherapy according to the SIOPEL protocol. And in 6 (33.3 %) patients, according to the results of a morphological study, the HB structure variant was interpreted as a “pure” fetal variant. Further therapy in this group of patients was not performed. The analysis of the results of treatment of these 6 patients without the use of chemotherapy is presented in our article. Results. The average age of patients is 3.7 (1–6) years, the median is 3.7 ± 2.0. Boys/girls – 4:2. In all cases, there was an asymptomatic course of the disease, a neoplasm was detected by chance during an ultrasound scan. All children had an elevated AFP level in the range of 95.2–695 (286.0 ± 116.8) IU/ml. Distribution according to PRETEXT I/II – 2 (33.3 %) and 4 (66.7 %) patients, respectively. Patients did not have additional PRETEXT criteria and metastases. Surgical treatment was performed by the laparoscopic method in 2 of 6 patients. Scope of operation: right-sided hemihepatectomy – 3, left-sided – 1, bisegmentectomy – 1, atypical resection – 1. Lymphatic dissection in the area of the hepatoduodenal ligament was not performed. There were no complications of treatment and repeated surgical interventions. The radicalness of the intervention in the volume of R0 was confirmed by histological examination in all patients. Morphological examination in all cases revealed a “pure” fetal version of the structure of the tumor. All patients are alive without signs of relapse at follow-up periods of 14.7 to 59.2 (32.0 ± 18.7) months. Conclusion. Using the system of therapeutic stratification into risk groups CHIC allows you to effectively distinguish patients with very low-risk groups, and for some children with a “pure” fetal version of the histological structure of the tumor, only the surgical approach can be used for treatment. At the same time, the short observation period for the patients and their small number do not allow us to draw final conclusions and dictate the need for a multicenter study. It should be noted that this cohort of patients requires careful observance of the post-therapeutic observation algorithm.

Актуальность. Ретинобластома — злокачественная опухоль эмбриональной нервной сетчатки. Целью лечения является не только сохранение жизни и зрения, но и минимизации системных осложнений, косметического дефекта, что достигается благодаря развитию методики селективной интраартериальной химиотерапии (СИАХТ). Повторное проведение СИАХТ в момент катетеризации a. ophtalmica сопровождается кардиореспираторными нарушениями (КРН). В статье проводится анализ эффективности и безопасности ретробульбарной блокады (РББ) 0,5% раствором ропивакаина для предотвращения или уменьшения КРН. Материалы и методы. В ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» пациентам с ретинобластомой в условиях общей анестезии (ОА) в 2017–2018 гг. проводились процедуры СИАХТ (n = 267). 83 пациента являлось первичными. У 83 % из них при проведении второй процедуры СИАХТ возникла легкая и умеренная степень КРН, у 17 % пациентов, которые и были включены в исследование, развились выраженные КРН (n = 14); для профилактики КРН при проведении третьей процедуры СИАХТ была выполнена РББ. Результаты. У 4 (28,57 %) пациентов после проведения РББ при третьей процедуре СИАХТ развития КРН не отмечалось, у 5 (35,7 %) пациентов после выполнения РББ проявления КРН снизились до умеренной и у 5 (35,7 %) — слабой степени выраженности. После проведения РББ отмечались меньшее повышение сопротивления в дыхательных путях на вдохе (Pinsp 25,4 ± 7,4 см вод. ст. vs 33,8 ± 3,2 см вод. ст. при ОА) и более стабильная гемодинамика. При проведении РББ 0,5% раствором ропивакаина объемом до 1,5 мл у детей с ретинобластомой осложнений не отмечалось. Заключение. Выраженные кардиореспираторные осложнения часто наблюдаются во время повторных сеансов СИАХТ и могут быть потенциально опасными для жизни. Использование РББ при выраженных КРН может способствовать снижению частоты и степени их выраженности.

Diagnostic value of preoperative and intraoperative imaging of follicular thyroid tumors in children was assessed. Between 1982 and 2012, a total of 96 patients aged from 3 to 17 years were treated. There were 30 patients with minimally invasive thyroid cancer and 66 with follicular adenoma. The preoperative imaging methods were found to be capable of suspecting malignancy, however, they were unable to differentiate benign from malignant tumors. Minimally invasive follicular cancer was diagnosed in 76,7 % of patients using the findings of ultrasound tomography, in 66,6 % by fine-needle biopsy and in 60 % of cases by urgent histological test. Urgent histological test for patients with follicular thyroid lesions is justified in cases with preoperative cytological diagnosis of follicular thyroid tumor and suspicion of cancer. Results of urgent histological test confirmed the diagnosis of minimally invasive thyroid cancer in 90 % of patients. Routine histological examination allowing capsular or vascular invasion to be detected is the main morphological diagnostic method for patients with follicular thyroid nodes.