V.A. Levin (ed). Cancer in the Nervous System

Abstract

In recent years several text books have been published in the field of neuro-oncology. Cancer in the Nervous System is the second edition of a multi-author text, encompassing both primary central nervous system tumors and neurological complications of systemic cancers. The latter part covers metastatic and nonmetastatic complications, both of the central and peripheral nervous systems; it covers complications of both hematological malignancies and solid cancers; it has important chapters on pain management in cancer patients, altered mental status, neurocognitive function and on psychiatric/psychosocial issues. The presence of a chapter on pain management is especially to be welcomed, as this is a prominent symptom in neuro-oncology. With this scope, the book should be able to serve as a ‘stand alone’ for all disciplines involved in the care of patients with primary brain tumors and with neurological complications of systemic cancer. There are some drawbacks to this book, however. The chapter on treatment of high-grade gliomas bluntly states on page 117 that “Based on these studies the combination of conventional irradiation and carmustine became the standard treatment regimen for malignant gliomas”, without revealing that this view is not generally shared. The chapter on radiotherapy in low grade glioma would be more clearly understood if the remarks on a wait-and-see policy were made before discussing the benefits of radiotherapy. Some new and exciting areas are hardly mentioned, such as the discovery of the different biological behavior of oligodendrogliomas with combined 1p and 19q loss. Finally, some of the figures are rather old fashioned. More importantly, I do not consider this book very suitable for students and residents in neuro-oncology. The approach to the treatment of certain diseases is not well balanced. For instance, the chapter on brain metastases contains a section on treatment, which begins with edema treatment including mannitol and hyperventilation. A section on prognosis in this disease is absent, including any remarks on the relevance of systemic disease for the prognosis of these patients (after all, the median survival is4 months). In the absence of a proper understanding of the prognosis, well founded treatment decisions are impossible. The same criticism holds true for the chapter on leptomeningeal metastases. In this chapter, emphasis is put on intrathecal treatment, without critical discussion of this approach. It also lacks references to the favorable outcome observed in patients with leptomeningeal metastases of breast cancer treated with systemic chemotherapy, which is particularly striking in view of the emphasis put on experimental agents in the approach to leptomeningeal metastases. Nevertheless, this is a very useful reference book, with numerous informative chapters. In my opinion, this volume has its greatest value if used in combination with other neuro-oncology textbooks.