Pediatric CNS Tumors
http://www.100md.com
《新英格兰医药杂志》
Despite the tremendous strides that have been made in developing successful therapies for many pediatric cancers, certain types of brain tumors still strike terror in the minds of parents, patients, and physicians. Pediatric CNS Tumors offers a concise account of the various histologic types of brain tumors in children and provides clear descriptions of current management and leading-edge technology. The book is written at a level of sophistication that will make it useful to physicians who are directly involved in the care of children with tumors of the central nervous system. Yet it will also be of interest to a broader audience, because it integrates information from a wide array of subspecialties that contribute to the optimal care of a child with a brain tumor. Because the tumors that arise in the developing brain are markedly different from tumors in adults and principally involve primary rather than metastatic disease, this book fills a niche.
A helpful feature, mentioned by the editors, is the roster of authors, who are affiliated mainly with a single institution, at the University of California, San Francisco. Rather than leading to provincialism, this structure makes possible the presentation of a coherent philosophy regarding complex management decisions. In most institutions, decisions about treatment for pediatric patients with brain tumors require coordinated input from several disciplines, and such an approach is evident in the organization and content of this book. That said, in some instances, the treatment strategies presented may differ slightly from practices at other institutions and, as with any complex and evolving area of medicine, should be interpreted with some flexibility.
For the most part, the book's chapters are devoted to the major histologic types of pediatric tumors of the central nervous system and include sections on epidemiology, pathology, imaging, and therapy. This scheme leads to some degree of repetition in chapters that discuss gliomas but focus on four anatomical compartments. However, there is merit to organizing the chapters in such a manner, because, for example, the biology of brainstem gliomas differs considerably from that of cerebellar astrocytomas, as do therapies for the two types of tumors. The format also increases the stand-alone usefulness of various chapters as reference sources. The final 4 chapters address imaging, surgery, chemotherapy, and radiation therapy in a more comprehensive manner than do the 11 chapters on various types of tumors. Since many pediatric patients with brain tumors are enrolled in cooperative-group clinical trials, a description of the design and results of previous research studies is presented in individual chapters. This provides an important historical perspective.
Two aspects of the care of pediatric patients should have received more comprehensive treatment in this book. The first is management of long-term follow-up care of survivors. As might be imagined, the tumor itself, as well as surgery, radiation therapy, and chemotherapy, can have important effects on the developing brain and pose lifelong sequelae. A multidisciplinary approach to optimizing the health and function of survivors is considered a key component of therapy at many medical centers. A description of the organization of a comprehensive brain-tumor clinic and the approach to long-term care would benefit many readers. The second aspect relates to the ineffectiveness of treatment for several types of newly diagnosed and recurrent brain tumors. Palliative care has a critical role in the treatment of patients not only with terminal illnesses, but also with potentially life-threatening diseases. Perhaps more important, such an approach can help guide families along a sometimes long and difficult road. Thus, it is realistic to consider pediatric palliative medicine as an important component of the management of such cases.
These criticisms aside, this up-to-date book, which includes some of the exciting recent advances in the molecular pathology of pediatric brain tumors, is well organized and offers a unified and comprehensive reference beyond what can be found in textbooks. It will be useful for practitioners in a broad cross section of medical specialties that intersect in this fascinating yet sometimes devastating type of cancer.
Gregory E. Plautz, M.D.
Cleveland Clinic
Cleveland, OH 44195
plautzg@ccf.org(Edited by Nalin Gupta, An)
A helpful feature, mentioned by the editors, is the roster of authors, who are affiliated mainly with a single institution, at the University of California, San Francisco. Rather than leading to provincialism, this structure makes possible the presentation of a coherent philosophy regarding complex management decisions. In most institutions, decisions about treatment for pediatric patients with brain tumors require coordinated input from several disciplines, and such an approach is evident in the organization and content of this book. That said, in some instances, the treatment strategies presented may differ slightly from practices at other institutions and, as with any complex and evolving area of medicine, should be interpreted with some flexibility.
For the most part, the book's chapters are devoted to the major histologic types of pediatric tumors of the central nervous system and include sections on epidemiology, pathology, imaging, and therapy. This scheme leads to some degree of repetition in chapters that discuss gliomas but focus on four anatomical compartments. However, there is merit to organizing the chapters in such a manner, because, for example, the biology of brainstem gliomas differs considerably from that of cerebellar astrocytomas, as do therapies for the two types of tumors. The format also increases the stand-alone usefulness of various chapters as reference sources. The final 4 chapters address imaging, surgery, chemotherapy, and radiation therapy in a more comprehensive manner than do the 11 chapters on various types of tumors. Since many pediatric patients with brain tumors are enrolled in cooperative-group clinical trials, a description of the design and results of previous research studies is presented in individual chapters. This provides an important historical perspective.
Two aspects of the care of pediatric patients should have received more comprehensive treatment in this book. The first is management of long-term follow-up care of survivors. As might be imagined, the tumor itself, as well as surgery, radiation therapy, and chemotherapy, can have important effects on the developing brain and pose lifelong sequelae. A multidisciplinary approach to optimizing the health and function of survivors is considered a key component of therapy at many medical centers. A description of the organization of a comprehensive brain-tumor clinic and the approach to long-term care would benefit many readers. The second aspect relates to the ineffectiveness of treatment for several types of newly diagnosed and recurrent brain tumors. Palliative care has a critical role in the treatment of patients not only with terminal illnesses, but also with potentially life-threatening diseases. Perhaps more important, such an approach can help guide families along a sometimes long and difficult road. Thus, it is realistic to consider pediatric palliative medicine as an important component of the management of such cases.
These criticisms aside, this up-to-date book, which includes some of the exciting recent advances in the molecular pathology of pediatric brain tumors, is well organized and offers a unified and comprehensive reference beyond what can be found in textbooks. It will be useful for practitioners in a broad cross section of medical specialties that intersect in this fascinating yet sometimes devastating type of cancer.
Gregory E. Plautz, M.D.
Cleveland Clinic
Cleveland, OH 44195
plautzg@ccf.org(Edited by Nalin Gupta, An)