PRINCIPLES AND PRACTICE OF PEDIATRIC ONCOLOGY

Sinopse

Shortly after the first edition of Principles and Practice of Pediatric Oncology was published in 1989, it became the single most important reference work for pediatric oncologists at all levels of training and experience. Each subsequent edition has provided the reader with more information, and this is certainly the case with the fourth edition. There are now 58 rather than 57 chapters, and the number of pages has grown from more than 1400 to more than 1600, a modest increase in view of the increasing body of new basic science and clinical information. However, I must confess that I did not reread every chapter. This review cannot do more than briefly mention some of the newer features and comment on some of the exceptionally useful chapters. The book has five general sections: "Basic Issues in Pediatric Oncology," "Diagnosis and Evaluation of the Child with Cancer," "Principles of Multimodal Therapy," "Management of Common Cancers of Childhood," "Supportive Care of Children with Cancer," and "Other Issues Arising at Diagnosis, during Therapy, and after Cessation of Therapy." Each of these sections includes a chapter on every conceivable relevant topic. In this way, the editors create a structure that ensures that nothing will be left out. Although this inevitably leads to considerable redundancy, it enables each chapter to stand alone and to deliver as complete a review as the title promises. A welcome reorganization of the section on basic issues has led to a series of six excellent chapters; all of them will be enormously useful to trainees and to mature pediatric oncologists who have not been able to keep up with every aspect of basic science. The first chapter contains information from the Surveillance, Epidemiology, and End Results program on incidence and survival, providing data with which all pediatric oncologists should be familiar. Although some might find the chapter on epidemiologic methods short on a discussion of environmental factors in childhood cancer, the authors appear to recognize the lack of evidence for etiologic factors that are attributable to the environment and choose instead to stress methodology and interpretation of epidemiologic data. In the chapter entitled "Molecular Basis of Childhood Cancer," the text is virtually unchanged, but the figures are clearer and will reproduce better as slides. There is considerably more information in the tables: more cloned genes (but unfortunately still not an up-to-date list), more altered transcription factors in leukemia, and 150 more references, for a grand total of 650. The chapter on childhood cancer and heredity is an especially excellent addition to this section. No diagnosis has been omitted from the section on management of common cancers, and although the 26 chapters are not structured in precisely the same way, each includes features of epidemiology, diagnosis, and treatment. In some cases, even late effects of treatment are discussed, but one needs only to refer to the chapter on the late effects of treatment for an excellent discussion of all possible long-term complications. Unfortunately, here the authors cite an inflated projection of the proportion of expected survivors of childhood cancer in the U.S. population; it is not possible to have 1 in 250 persons surviving by 2010 if the prevalence of newly diagnosed disease in children and adolescents between birth and 19 years of age is less than 1 in 300. If as many as two thirds are cured, the survivors should number about 1 in 450. Some chapters have been omitted, and the information contained in them has been incorporated into other chapters: the chapter on hematologic support now also discusses cytokines, which earlier were covered in a separate chapter, and "Lymphoproliferative Disorders and Malignancies Related to Immunodeficiency" is now also a single chapter; these are rational changes, and both work well. The chapter dealing with pain is now called "Symptom Management" and indeed covers other acute complications, such as nausea and vomiting. "Nursing Support" not only covers the more practical aspects of these same problem symptoms but also effectively deals with every situation requiring nursing intervention in pediatric cancer; it should be read by all oncology nurses and those contemplating oncology nursing. Alternative therapy is now "Complementary and Alternative Medical Therapies in Pediatric Oncology," a reflection of modern thinking. One chapter, "Emergencies in Pediatric Oncology," deserves to be recognized for being completely revised, with updated references, algorithms, and tables that are easier to follow; a more detailed list of the etiology of common neurologic and other types of emergencies; and a new section on intravenous and intrathecal drug errors or overdoses that require immediate action. This is clearly the most important book on pediatric cancer. It should be accessible to all health care professionals who treat children -- pediatricians, pediatric surgeons, radiation oncologists, pathologists, and pediatric oncologists. Medical oncologists and basic scientists will also find it a useful addition to their bookshelves. Since medical oncologists are often faced with younger patients, they are likely to benefit from specific information regarding pediatric neoplasms and from reviewing the history of therapeutic successes in pediatric oncology. Although these successes were made possible in part by the responsiveness of childhood cancers, nonpediatricians would do well to emulate the examples of a multidisciplinary approach and the application of clinical trials that are found throughout the book. In the preface, the editors predict that "the field of genomics holds extraordinary promise for the study of childhood malignancies." My prediction is that the study of childhood cancer will continue to contribute greatly to our knowledge of the function of cancer genes. The best chapters have just the right perspective, including major historical achievements, concisely presented current status, and an indication of what we still need to know. A more tightly edited volume with citations to fewer references that are not likely to be sought out and read should be considered the next time around; it would reduce the number of pages and render the book more useful, since it would be carried home more often. Anna T. Meadows, M.D. Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.

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