Alexander F. Karelin

For modern treatment schemes for bone sarcomas (BS), overall survival of children and adolescents is 60–70 %. This treatment can be accompanied by disruption of intraosseous metabolism which leads to decreased bone mineral density (BMD). Clinical equivalents of decreased BMD are osteoporosis/osteopenia which are reported in 45 % of patients cured of various malignant neoplasms. Children and adolescents with BS have higher incidence of osteoporosis (43–65 % of cases) compared to patients with other types of malignant tumors. Aim. To determine the rate of BMD abnormalities and risk factors of osteoporosis in children and adolescents who completed BS therapy. Results of scientific articles published in the eLIBRARY, PubMed, Scopus databases, as well as on the Research Gate, Google Scholar platforms were analyzed. In patients with BS, the following main etiologic and pathogenetic mechanisms of BMD decrease were identified: tumor process extent, mutilating surgical interventions, implantation of various implants, limitation of mobility, administration of cytostatic drugs, high-dose radiotherapy, genetic predisposition. BMD abnormalities and bone fractures develop even in unaffected by the tumor parts of the skeleton. Considering high risk of osteoporosis in patients with BS, it is important to start diagnostic process and correction of this complication as soon as possible after the start of antitumor therapy, as well as monitor BMD even in patients in long-term remission.

Von Hippel–Lindau disease is a rare, congenital, multisystemic hereditary disorder classified as a phakomatosis. It is characterized by multiple benign and malignant angiomatous tumors. Hemangioblastoma of the central nervous system is classified as a rare, highly vascularized, benign tumor. This is one of the most common tumor types associated with von Hippel-Lindau disease. The condition usually has a long asymptomatic phase, so it often goes undiagnosed until adulthood. This work presents positive rehabilitation outcomes for a 16-year-old girl with von Hippel-Lindau disease, which manifested as multiple cystic and solid lesions in the posterior cranial fossa. Rehabilitation took place at the Medical and Rehabilitation Research Center Russkoye Pole. A long rehabilitation period allowed for the gradual achievement of clinical goals, such as restoration of clear consciousness, safe and stable movement patterns, motor skills, voice and respiratory functions, and functional swallowing. A significant improvement in quality of life was observed after the patient received comprehensive, long-term medical rehabilitation from a multidisciplinary team. The local psychologists helped the girl and her mother overcome their difficult situation caused by the disease and adopt an optimistic outlook on their future, despite the high risk of new tumors.Continuous rehabilitation efforts enabled the girl to successfully graduate from school and enter a higher education institution. The girl did not fully recover. Targeted therapy with belzutifan was prescribed because of the presence of slow-growing lesions in the brain and spinal cord. The planned duration of the targeted therapy is three years.

Introduction. The number of children and adolescents cured of malignant neoplasms (MN) is growing worldwide. An important task of modern pediatric oncology is to maintain quality of life (QOL) after the end of intensive antitumor therapy.The aim of the study was to study the QOL of patients with MN of the kidneys at the stages of rehabilitation.Results and discussion. Patients and parents filled out the relevant forms of the PedsQuality of Life Inventory Generic Core Scales (PedsQL) general quality of Life assessment questionnaire. A comparative analysis of the patientsʼ QOL was performed depending on the age of the patients at the time of the disease, the duration of remission, and the type of renal insufficiency.Conclusions. The QOL assessment technique confirms the effectiveness of rehabilitation technologies in patients with renal insufficiency; after rehabilitation treatment, regardless of the type of tumor, an increase in QOL parameters is noted. The QOL estimates made by parents of patients with Wilms tumor (WT) are lower than those in pediatric forms of PedsQL, regardless of the volume of the tumor lesion and the age of the patients. The lowest QOL is observed in WT patients in the first 3 years after the end of antitumor therapy, which should motivate specialists and parents to start rehabilitation as early as possible. On 10–12 years of follow-up, QOL indicators decrease, probably due to the cumulative effect of other medical and social risk factors, preventing the achievement of the population level of QOL.

Relevance. The limited selectivity of antitumor therapy for central nervous system neoplasms entails the risk of dental morbidity in patients.The aim of the study is to assess the severity of damage to the dental hard tissues in patients with tumors of the posterior cranial fossa (medulloblastoma, astrocytoma) and other tumors of the central nervous system.Materials and methods. Three comparison groups were established based on the toxicity profiles of antitumor therapy among 251 patients at the "Russian Field" treatment and rehabilitation scientific center, to assess the characteristics of oral health status. The assessment of oral health status included diagnosing the carious process and calculating the DMFT index. The degree of damage to the dental hard tissues was evaluated on a four-point scale. The clinical manifestations of oral cavity pathology were compared using the Z-criterion for multiple pairwise comparisons of data, with adjustments for multiple testing (Multiple pairwise comparison Z-test for proportions with multiple testing correction) using the free R software version 3.5.2. The null hypothesis of equal indicators in the compared groups was rejected with a 95% confidence probability when comparing groups of patients.Results. Dental hard tissue pathology was significantly more prevalent in patients with medulloblastoma compared to those diagnosed with astrocytomas and other central nervous system tumors. Additionally, the prevalence of dental hard tissue pathology progressively decreased as the observation period following the completion of antitumor remission was extended.Conclusion. The most severe damage to dental hard tissues is observed in patients with medulloblastoma, who undergo more intensive antitumor therapy compared to those with CNS tumors of other histological types.

Background. The success of pediatric oncohematology makes the rehabilitation of cured patients more and more relevant. Physiotherapy for cancer patients is an underdeveloped method of treatment.The purpose of the study – to analyze the use of physiotherapy techniques in the rehabilitation practice of pediatric oncologists, hematologists.Materials and methods. The authors completed their research based on the materials of the activities of the Department of Physiotherapy of the Clinical Rehabilitation Research Center “Russian Field” for the period 2018–2021.Results and discussion. Approximately 2,000 patients per year with oncohematological diseases during the period of remission receive evidence-based physiotherapeutic methods of treatment (electrotherapy, inhalations, magnetotherapy, balneotherapy, massage). Doctors note the effectiveness and safety of the therapy.Conclusion. Knowledge of the evidence-based basis of physiotherapy treatment allows doctors to choose an adequate method and increase the effectiveness of rehabilitation.

Relevance.The relevance of the literature review presented by the authors is due to the diversity and complexity of the differential diagnosis of tumors of the orofacial zone in children and adolescents. Against the background of the absolute predominance of benign neoplasms, about 10-20% falls on the share of malignant neoplasms in this area. In this regard, polyclinic specialists often do not show sufficient oncological alertness, which leads to an unjustified lengthening of the diagnostic period and late diagnosis of malignant neoplasms.The purposeof the literature review is to discuss the results of studies on the epidemiological, clinical and therapeutic features of the tumor process in the orofacial zone in children and adolescents.Materials and methods.The searching of publications on the subject of the review were performed in the databases: https://www.ncbi.nlm.nih.gov/, https://elibrary.ru/cit_title_items.asp, https://www.researchgate.net/, https://elibrary.ru/. The authors describe the clinical manifestations of tumors depending on the location of the lesion and histological affiliation. The initial symptoms of both malignant and benign neoplasms are often nonspecific. Prevailing benign neoplasms can only be treated by surgery. Much less often in children and adolescents, malignant neoplasms are also found: squamous cell carcinoma of the oral cavity, Langerhans cell histiocytosis and others, which are treated in accordance with the principles of complex / combined anticancer therapy, including courses to minimize the amount of rehabilitation. Results.Timely diagnosis and prevention of the development of neoplasms in the orofacial area can reduce the severity of morphological and functional disorders in children and adolescents. Despite the use of effective methods of surgical or combination therapy, many need rehabilitation measures.Conclusions.The optimal position of a pediatrician, therapist, dentist, or surgeon at the stage of tumor diagnosis should be the implementation of oncological alertness, which implies an active approach without long-term "dynamic observation" of patients. Oncological alertness, especially among dentists, will improve the results of antitumor therapy in patients with Orofacial tumors.