Современные подходы в лечении детей с рабдомиосаркомой мочеполовой системы

Органы мочеполовой системы (мочевой пузырь/простата, уретра, влагалище, вульва, матка, паратестикулярная зона) среди всех локализаций рабдомиосарком (РМС) поражаются в 20-26% наблюдений. На основе стратификации пациентов на группы риска разработана риск-адаптивная терапия, которая позволила у 80% пациентов в прогностически благоприятных группах обеспечить длительную выживаемость и сократить число калечащих операций: число цистэктомий уменьшилось с 78% впротоколе IRS-I (1972-1972) до 9% в IRS-IV (1993-1997); число гистерэктомий также уменьшилось с 48% в исследованиях IRS-I/II до 22% в IRS-III/IV. Общая выживаемость детей с РМС мочеполовой системы в исследованиях COG и SIOP не отличается, однако безрецидивная выживаемость в протоколе SIOP при РМС мочевого пузыря/простаты была хуже, что связано с более сдержанным отношением к применению лучевой терапии. Остаются нерешенные вопросы времени second-look операций, режимов лучевой терапии, лечения рецидивов и первично диссеминированных форм. Кроме того, достигнуто плато в результатах лечения на стандартных режимах терапии (VAC, IVA).
Большие надежды связывают с применением новых препаратов при РМС (иринотекан), в том числе и таргетного действия. Разрабатываются технологии брахи- и внутриполостной лучевой терапии

рабдомиосаркома, простата, мочевой пузырь, матка, влагалище, вульва, паратестикулярная зона

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