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Book Reviews |
The Cleveland Clinic Foundation
Tumors of the Pediatric Central Nervous System. Edited by Robert F. Keating, James Tait Goodrich, and Roger J. Packer. Thieme, New York, 2001, 576 pp. $249.95, ISBN 0-86577-848-5
This textbook succeeds in addressing the essential topics related to the historical background, basic science, diagnosis, and treatment of pediatric brain and spinal cord neoplasms. In the preface, the editors state that one purpose is to "bridge the wide divide between primary care and the specialist's focus," and this goal is accomplished. Although many of the chapters could be expanded into books themselves, this book is one of very few that could sit on the desk as a near-comprehensive reference for every neuro-oncologist and neurosurgeon. It is also a wonderful reference that pediatric neurologists, oncologists, and radiation oncologists should strongly consider having on their bookshelf. It would be a very useful text for any physician or student needing a comprehensive reference on this subject. This book is oriented to clinicians caring for children with CNS tumors and, aside from the chapters on gene therapy and chemosensitivity, is not meant to address the nonclinical aspects of the field. The vast majority of the book is medically sophisticated, but it is written so that a parent of a child with a CNS tumor would also be able to bypass the more technical aspects of the discussion and still gain useful knowledge.
As with any text written by 69 authors, the individual style of the authors is visible to the reader, but the book is tightly edited, so that there is consistency from one chapter to the next. The text is written in four sections: Current Diagnosis and Therapeutic Approaches, Intracranial Tumors, Spinal Cord Tumors, and a final section, Outcomes and Complications. The first and fourth sections contain topics not covered in other textbooks of this type and are one feature that makes this textbook stand out from others. The clinical sections are laced with bullet summaries of a topic, referred to as "boxes." These are placed within the body of the text in bold type, set within a shaded box, which enables the reader to quickly grasp the important concepts that are presented. The editors have taken great efforts to ensure that the images, which include color photomicrographs, MRIs and CTs, patient photographs, drawings, and operative photographs, are all of excellent quality. There are a number of useful tables throughout the textbook as well. The chapters are well referenced with appropriate and up-to-date literature citations.
The first section makes up more than one third of the text and opens with a fascinating review of the history of pediatric neuro-oncology, from antiquity to about 50 years ago, and I only hope this chapter is expanded in following editions of the book. The first section also includes brief reviews of the epidemiology of brain tumors and diagnostic principles. The chapters on neuroimaging (26 images and 23 boxes) and neuropathology (123 photographs and 303 references) are nothing short of spectacular. The first section contains complete discussions of the anesthesia and critical care considerations, which are new to textbooks of this type, as well as more conventional discussions on radiotherapy, stereotactic radiosurgery, chemotherapy, and gene therapy. As a nonscientist, I was delighted to find the gene therapy chapter very readable. Sections II and III contain reviews of all the major tumor types. Most of these chapters follow a standard format that was probably requested by the editors, although some do not. The majority of chapters reflect no author bias in terms of preferred method of treatment, with the discussion supported by literature-based reports. The use of ample and appropriate radiographic images, microscopy, and tables is continued in these chapters. The quality of these chapters, based on the depth of review and number of current references, ranges from very good to outstanding, with only one chapter seemingly out of date. The fourth and final section contains chapters of postoperative considerations, rehabilitation, cooperative group trials, chemosensitivity testing, late effects, and ethical considerations. The chapter on postoperative considerations is a tightly written and comprehensive overview of the postoperative care of neurosurgical patients, and although not a substitute for an experienced clinician, it should probably be required reading for every pediatric and neurology resident rotating through a pediatric intensive care unit. Likewise, the chapter on cooperative group trials contains important insights that may not be known to those not intimately involved in the concept of clinical trial design. This chapter would also be appropriate for parents motivated to gain an understanding of how doctors go about finding the best treatments for these illnesses and answers in detailed terms why we cannot simply treat the child with "the best therapy."
In summary, this textbook accomplishes the intended goals. Because of size limitations, no textbook can be entirely authoritative. With few exceptions, the chapters are current with regard to the date of publication of this text. The book is well written and easy to navigate. I have looked through all of my neuro-oncology textbooks, and I did not find a volume that comes close in terms of the number of radiographic images or photomicrographs (including color images when appropriate) used in this book, which by themselves would justify its cost. The topic summaries (the boxes) will be most helpful for less experienced readers and are used appropriately throughout the book. This is a handsome book, printed on thick gloss paper that will hold up for years. I can highly recommend this book to the wide audience for whom it was written.
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