Book Review
Neuro-Oncology of CNS Tumors
N Engl J Med 2006; 355:105July 6, 2006
- Article
Neuro-Oncology of CNS Tumors
Edited by Jörg-Christian Tonn, Manfred Westphal, James T. Rutka, and Stuart A. Grossman. 706 pp., illustrated. Berlin, Springer-Verlag, 2006. $229. ISBN: 3-540-25833-7The improved treatment of brain tumors and our increasing understanding of the biologic changes that lead to their formation have fueled a growing interest in this large group of uncommon neoplasms. Many books devoted to this topic have been published recently, and Neuro-Oncology of CNS Tumors is one of the newest additions. This five-part, redundantly titled textbook is edited by an international group of four experts, and numerous authors have contributed material to its 57 chapters.
This book is one of the few that devote equal attention to topics in pediatric and adult neuro-oncology. The first part of the book discusses the major types of brain tumors, many of which are described again in the part on pediatric neuro-oncology; this duplication sometimes leads to confusion. For example, chapter 9, entitled “Adult Tumors of Pediatric Origin,” is devoted to pediatric tumors that occur in adults, but it has little to add to the detailed chapters in the pediatric section, some of which also discuss these tumors in adults. Neuro-Oncology of CNS Tumors contains several contradictions, such as the recommendation in chapter 34 that some patients with intracranial ependymomas require immediate postoperative radiotherapy, whereas in chapter 9 a different group of contributors state — without any qualification for particular subgroups of patients — that there is no role for immediate radiotherapy.
Many of the chapters detail the usual information on the clinical presentation, pathologic findings, and neuroimaging of brain tumors, but none of them discuss recent data on treatment. Important topics that are missing include a discussion of randomized, controlled trials documenting the use of chemotherapy in children with a medulloblastoma (and the subsequent safety of reducing the dose of neuraxis radiotherapy) and the addition of temozolomide to cranial irradiation in the treatment of patients with a glioblastoma multiforme. These omissions date the book and limit its use.
Photomicrograph Showing Tumor-Cell Rosettes in Medulloblastoma of the Fourth Ventricle. Neuro-Oncology of CNS Tumors has a pleasing appearance and is easy to read. Computed tomographic and magnetic resonance images, which are plentiful throughout the chapters, greatly help to illustrate the contributors' descriptions. An ample number of pathological and surgical photomicrographs are reproduced clearly and in excellent color. However, in many areas the text is marred by awkward phrasing and placement of tables and figures. For example, in chapter 1, the reader is distracted from an otherwise comprehensive review of the pathology and classification of primary brain tumors by the absence of Tables 3 and 4, by the placement of Figure 4 more than 20 pages away from the matching text, and by figures that are not cited in their order of appearance. In this chapter, Table 1 has a vertical orientation, which makes it comprehensible only to those already familiar with the World Health Organization classification of tumors of the nervous system.
Several errors will leave the uninformed reader perplexed. For example, in chapter 34, the authors suggest that radiotherapy is appropriate for children with World Health Organization grade II — not grade III — ependymomas. Furthermore, they suggest that the recommended dose of radiation for these children is 5.4 Gy, but it should be 54 Gy.
The broad scope of this book may appeal to students of adult or pediatric oncology, neurology, neurosurgery, or radiation oncology. It is an excellent introduction to the topic, but the practicing clinician will need to go elsewhere for specific guidance regarding treatment of these uncommon tumors.
Lisa M. DeAngelis, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021
deangell@mskcc.org
