Commentary: Lessons in Pediatric Neuropsycho-Oncology: What We've Learned Since Johnny Gunther

Abstract

In his paper, ‘‘Lessons in Pediatric NeuropsychoOncology: What We’ve Learned Since Johnny Gunther’’, Ris (2007) successfully accomplishes a formidable task. He provides a biographical and literary anchor that allows for the succinct summary of the history of neurooncological treatment, current status and standard of care, recent innovations and advances in the treatment of pediatric brain tumors. He also presents important information on current directions in both the measurement of neurocognitive late effects, and importantly, work that is being done to reduce the neurocognitive complications associated with the treatment of many childhood brain tumors. This is a brief, concise but comprehensive presentation. I do not believe that I have ever read an article that covered so much scientific ground in such a brief presentation. In this sense, the review raises the benchmark for literature summaries. Ris’s (2007) introduction to the paper begins with a reminder of the tragedy of childhood brain tumors that was so aptly and poignantly presented in the 1949 book, Death Be Not Proud written by the father of an adolescent who died from a particularly malignant brain tumor, glioblastoma multiforme. I was immediately struck by this reference because the book was required reading in one of my junior high school English classes. I had completely forgotten about this memoir. It is a wonderful book, and I do not know if it is still required reading in grade school, but if the reader of this commentary is not familiar with the book, he/she should immediately purchase and read it. Since 1949, neuro-oncologists have made incredible advances in the treatment of childhood brain tumors, but brain tumors remain a malignancy that is associated with significant neurocognitive and psychosocial late effect complications. While treatment advances are improving long-term survival, the childhood brain tumors remain a disease process that present a daunting challenge for all medical professionals in the area of pediatric oncology. Advances in treatment have occurred with many childhood brain tumors, but as Dr Ris reminds us, glioblastoma multiforme continues to be associated with only a 4–16% incidence of long-term disease-free survival. The article begins in the time period of John Gunther Jr’s diagnosis, treatment, and death, and then proceeds to review advances in the treatment of both brain tumors and the leukemias throughout the 1970s, 1980s and 1990s and brings us up-to-date regarding the current standard of care, and also late effects research.