|Home | About | Journals | Submit | Contact Us | Français|
Editors: R Pinkerton, P Plowman, R Pieters
728pp Price £145 ISBN 0-340-80775-X (h/b)
London: Arnold Hodder Headline.
Having no previous experience of formally reviewing a book, I felt that it would be sensible to base my comments on how valuable I had found the publication as a resource in patient management during my initial months as a consultant in paediatric oncology.
Hodgkin's disease has lately been in the news because of an increased incidence of breast cancer in long-term survivors; an intensive breast cancer screening programme has been introduced for individuals at risk. This lymphoma is sensitive to chemotherapy and radiotherapy, and opinions differ on the relevant merits of each treatment. Chemotherapy agents have potential side-effects of infertility, pulmonary fibrosis, cardiomyopathy and second malignancies. Radiotherapy can result in skeletal growth disturbances, and the cosmetic effects can be psychologically scarring. Second malignancies apart, long-term risks of radiotherapy include pulmonary fibrosis and cardiomyopathy. Hodgkin's disease is usually curable and therefore any moves to reduce treatment intensity at the cost of patient survival would be very unfortunate. The current UK clinical trial for children and teenagers with Hodgkin's disease is chemotherapy-based, using low doses of eight agents so as to 'dilute' any side-effects, and radiotherapy is used only for patients with resistant or metastatic disease. When presented with a patient with metastatic Hodgkin's disease, I consulted the appropriate chapter to assist me in planning treatment. This enlightened me on the history surrounding the current arguments regarding the management of these patients and as to why the future of Hodgkin's disease treatment is an area of major debate. Armed with the historical background I felt better able to critically review recent Hodgkin's disease trials before deciding how to proceed.
A major reason for the increasing survival of children with malignant conditions is improvement in supportive care (antibiotics, antifungal medication, nutrition) and hence the ability to use intensive regimens in the knowledge that toxic effects will usually be manageable. The supportive-care chapters of this book did not seem to reflect the importance of this aspect of care in clinical practice. One reason, probably, is the lack of convincing evidence for much of current supportive care practice, but this could have been an opportunity to present some of the debates. A case in point is the lack of any reference to tunnelled central lines and the associated risk of thrombosis in major veins. There is huge personal and centre variation in how suspected thromboses are investigated and managed, with little evidence for any particular approach.
In patients with chemotherapy-induced myelosuppression, 'rescue' is achievable by infusion of the patient's pre-chemotherapy haemopoietic stem cells. This allows more intensive (high dose) chemotherapy regimens to be used and the success of this approach depends on disease type. An excellent chapter details the major current clinical trials researching the success of high-dose chemotherapy in each of the solid tumour groups.
Since the first edition in 1992, Paediatric Oncology has become standard reading for trainees. I assume that more experienced colleagues still use the book, and certainly as a new consultant I will refer to the new edition frequently. The general layout and structure is reader friendly. I did find gaps when seeking help with complex patients, but no book can be comprehensive. At such times one turns to local, national and international colleagues. This new edition maintains the status of its predecessors as standard reading.