Paediatric Oncology (3rd edn)

Abstract

Cancer affects one child in 500 during the first 15 years of life. The number of patients surviving to 18 years has risen from around 1500 in 1971 to about 15,000 in the year 2000. With this in mind, the editors and contributors to this important text comprise an international group of pre-eminent paediatric oncologists, mainly practising in Europe. The work represents an authoritative source of reference for all aspects of the challenging field of childhood cancer. There is a uniform structure to each chapter with a useful synopsis of ‘key points’ at the end. The first section gives a fascinating insight into recent advances in the understanding of tumour and therapeutic biology. For radiation – the effects on DNA in ‘hierarchical versus flexible’ cell populations and apoptotic versus mitotic pathways for cell depletion. For chemotherapy – the effects on DNA damage, DNA synthesis blockade and mitosis disruption. The interaction of these therapies is related to current concepts of the molecular biology of cancer. The importance of national and international collaboration in clinical trials for the study of these rare diseases is emphasised. Their design and application is a paradigm for the study of malignant disease in any age. The heart of the text is a treatise on each individual tumour type. These include practical aspects of presentation, diagnostic imaging and treatment as well as the application of current molecular and genetic insights into each disease. Most paediatric malignancies are very sensitive to chemo- and radiotherapy. The importance of pre-operative treatment after accurate histological diagnosis is illustrated by safer operations, tissue sparing and limb salvage in nephroblastoma, hepatoblastoma and osteosarcoma, respectively. The stage of disease including local or metastatic and complete or incomplete excision has an important impact on outcome. The authors show that application of this knowledge has allowed a progressive decrease in the intensity of therapy for low-stage, low-risk malignancy, for which operation may be the mainstay of treatment with examples including nephroblastoma and neuroblastoma. Overall survival has been maintained with a reduction in the toxicity and long-term sequelae of therapy. There remain patients with all tumour types for whom the outlook is very poor. Treatment involves the use of intensive combination chemotherapy together with bone marrow ablation with transplantation or stem cell rescue. This is covered with each tumour type as well as in a comprehensive third section that also describes novel chemotherapy agents, including anti-tumour antibodies, anti-drug resistance and anti-angiogenesis agents as well as genetic medicine. To those practising in the field of paediatric oncology, the text is indispensable. The book is also commended to those who are curious about the biology of a group of rare diseases and the science behind their treatment.