Book Review

Neoplastic Diseases of Childhood

N Engl J Med 1996; 335:212July 18, 1996

Article

Neoplastic Diseases of Childhood
Edited by Carl Pochedly. 1603 pp. in two volumes, illustrated. London, Harwood Academic, 1994. $430. ISBN: 3-7186-5340-0

This new textbook of pediatric oncology reflects and memorializes the career of its editor, Carl Pochedly, who died last year. Pochedly was a founder of the American Society of Pediatric Hematology/Oncology and the founding editor of its journal, and his role as an international coordinator and catalyst is illustrated by the list of contributors to this book: 6 editorial advisors and 114 authors from 12 countries on 5 continents.

The length of this book is due not only to increased knowledge in the field but also to the inclusion of over 700 pages covering cancer biology, principles of diagnosis and treatment, complications, and supportive care. All the chapters are well written and extensively referenced, with a generous number of tables and illustrations. Murphy's chapter on the early history of pediatric oncology is particularly interesting, and Lilleyman's chapter on the techniques of bone marrow aspiration and biopsy is especially practical.

There are some imperfections. Some topics are covered twice; others are neglected. Rhabdoid tumor of the kidney, for example, is described both in the chapter on Wilms' tumor and in the chapter on other renal tumors, whereas several troublesome benign neoplasms, such as cystic hygroma, osteochondroma, and palmar or plantar fibromatosis, receive inadequate or no attention. In addition, although the quality of the illustrations is generally acceptable, some of the photographs are underexposed or overexposed, have poor resolution, or lack sufficient contrast; none are in color.

The most serious problem, however, is one shared by other clinical textbooks. When I was a pediatric resident in the early 1950s, my professor encouraged me to consult original references and to avoid textbooks, pointing out that textbooks are obsolete on the day they are published. In the Pochedly textbook, with few exceptions, the latest references are from 1991, three years before the book's publication, so there are substantial errors and deletions, as well as information that is no longer relevant. For example, the chapter on leukemia in infants speculates about the role of the c-ets-1 oncogene in relation to the characteristic 11q23 chromosomal abnormality. The critical gene, MLL, has been known for five years now. The chapter on the treatment of fungal infection does not mention fluconazole, the current drug of choice for mucocutaneous candidiasis in patients with cancer. There is also no mention of ondansetron, the highly effective antiemetic agent that has revolutionized the delivery of chemotherapy. An entire chapter is devoted to high-dose chemotherapy and bone marrow rescue for brain tumors, an approach that has turned out to be disappointing in terms of improving survival.

The question is whether clinical textbooks represent an obsolete tradition. With the ready availability of computers and on-line access to original articles, reviews, and critical commentaries in the current medical literature, why consult a textbook? The argument in favor of textbooks is that they organize information and provide a structure for easier learning. Pocket-sized manuals, however, such as the Williams Hematology Companion Handbook (edited by William J. Williams et al. 5th ed. New York: McGraw-Hill, 1996), can serve this purpose more conveniently and less expensively, and they are easier to revise.

Is the Pochedly textbook worth purchasing? For the student or young physician on a budget, the $430 would be better spent on a computer upgrade. However, pediatric hematology–oncology units may wish to add the book to their libraries, because it serves as a model for the collation and organization of information about neoplastic diseases in children, a milestone of progress in the field, a tribute to the remarkable national and international collaboration of specialists in childhood cancer, and a memorial to one of the field's leaders.

Donald Pinkel, M.D.
Driscoll Children's Hospital, Corpus Christi, TX 78411