Book Review

Cancer and the Skeleton

N Engl J Med 2000; 343:892-893September 21, 2000

Article

Cancer and the Skeleton
Edited by Robert D. Rubens and Gregory R. Mundy. 286 pp., illustrated. London, Martin Dunitz, 2000. $125. ISBN: 1-85317-756-3

This book contains 18 chapters by well-known specialists from the United States, Europe, and Australia. It covers physiology and pathophysiology, diagnosis (imaging and biochemical markers), therapy (radiation, chemotherapy, and surgical procedures), and the care of patients with bone tumors. Although primary bone tumors are mentioned, metastases from solid primary tumors and multiple myeloma are emphasized because of their frequent occurrence. Complete reference lists, updated through 2000, follow each chapter, and the book concludes with a detailed index.

The book contains some inconsistencies and oversights. For example, one author mentions that thyroid and kidney carcinomas commonly metastasize to the skeleton, whereas another author states that these tumors rarely travel to the bone. These differences are probably due to different methods of assessing the frequency and distribution of skeletal metastases; autopsy studies and bone scintigraphy may yield different results. The chapter entitled “Radiology and Magnetic Resonance Imaging” fails to mention that magnetic resonance imaging (MRI) can easily reveal the trabecular pattern of metastasis. Furthermore, recent publications describe the use of MRI for examining the skeleton (including coronal imaging of the pelvis, proximal femur, and proximal humerus), thereby obviating the need for bone scintigraphy with technetium-99m–labeled methylene diphosphonate as a method for detecting osseous metastases. Unfortunately, this MRI technique is not mentioned in the book.

The book is lavishly illustrated. The quality of the printed radiographs and bone scans varies from moderate to good. Apart from one figure, in which an MRI scan is printed in reverse, I could not find any flaws in the illustrations or legends.

I asked some of my colleagues their opinion of this textbook. An orthopedic surgeon, a radiation therapist, and an oncologist agreed that this monograph provides an attractive introduction but that more experienced specialists might find it somewhat superficial. There are not many books on osseous metastases. Because of the frequency of this condition and the emergence of new therapeutic strategies (especially the use of bisphosphonates), books of this kind are important to the medical community. I can recommend Cancer and the Skeleton to anyone looking for an introductory textbook on this subject.

Paul R. Algra, M.D., Ph.D.
Medical Center Alkmaar, Alkmaar, the Netherlands