|Home | About | Journals | Submit | Contact Us | Français|
James Markert, Vincent T. DeVita, Jr., Steven A. Rosenberg, Samuel Hellman Jones and Bartlett, Publishers: Sudbury, Massachusetts. 2004 316 pp. $59.50 0-7637-2640-0.
It may be clear to the readership of Neuro-Oncology that a book describing the basic science and clinical aspects of glioblastoma multiforme is urgently needed. Although not explicitly stated as an objective, it is clear that Glioblastoma Multiforme aims to bring basic researchers and clinicians together to translate modern findings into new therapies. The editors, James M. Markert, Vincent T. DeVita Jr., Steven A. Rosenberg, and Samuel Hellman, introduce the unique biology of glioblastoma multiforme and the unique barriers to its effective treatment. The 16 chapters of this book are organized into three large categories: the basic science of glioblastoma, the clinical aspects of this entity, and new treatment approaches that are emerging from the laboratory into the clinic. Each chapter is succinct and self-contained. This book is not intended for the dilettante or the fainthearted, as each chapter describes in depth the state of the knowledge of the field. This book appears geared mainly for scientists and clinicians with a significant knowledge of the field who wish to gain a comprehensive understanding of subjects with which they are not most familiar.
In the basic science section, the first chapter, written by Chengkai Dai and Eric Holland and titled “Astrocyte Differentiation States and Glioma Formation,” describes the molecular pathways leading to glioma formation. I must admit that I embarked on this chapter with some trepidation, as the literature in this field had never appeared to me to be completely congruous, nor was my knowledge of it very solid. Nevertheless, Dai and Holland clarify to the degree possible the influence that cell differentiation has on gliomagenesis. The chapter is filled with ideas and testable hypotheses and potential research projects. The second chapter, by Alice Brown and her colleagues, aims to classify glioblastoma multiforme by molecular genetics, moving from the basics of molecular pathways to pathological classification based on cell cycle dysfunction and mutations of oncogenes and tumor suppressor genes. The final two chapters of the first section address angiogenesis in glioma and the molecular epidemiology of glioblastoma.
The second portion of the book addresses clinical aspects of glioblastoma multiforme and maintains the energetic pace that characterizes the first portion of the book. In the first chapter, Sarah Nelson and Soonmee Cha describe the imaging of glioblastoma multiforme. The University of California at San Francisco group has been a leader in this field. This chapter describes the accepted techniques of the radiology of glioma as well as techniques with experimental features, such as the use of CBV and ADC (cerebral blood volume and apparent diffusion coefficient) mapping in the imaging of cellular metabolism. Stephen Hentschel and Fred Lang’s chapter on the current surgical management of glioblastoma does a great job of clarifying surgical tenets of glioma surgery, for both neurosurgeons and non-neurosurgeons; this is a a field whose literature is often contradictory and riddled with inconclusive class III studies. The chapter on radiation therapy presents a history of Radiation Therapy Oncology Group trials that have led to the current dosing for external beam radiation beam therapy. A chapter by Ian Parney and Susan Chang describes the use of chemotherapy in this disease; it discusses the use of conventional agents as well as some experimental approaches with novel biological agents and intratumoral chemotherapies.
The last section of the book, considering new treatment approaches for glioblastoma multiforme, represents a culmination of translational research, which is on the verge or in the midst of early clinical trials. The chapter on adoptive immunotherapy for malignant glioma by John Sampson and his colleagues describes one of the most promising fields of immunotherapy to date. By this approach, based mainly on findings of Rosenberg’s group, tumor-infiltrating lymphocytes are cultured in vitro and reinfused into patients that have been partially lympho-depleted. This important and dramatic finding awaits publication of larger studies and has yet to be attempted in patients with intracranial tumors. Jim Markert’s chapter on viral therapies for treatment of malignant glioma presents through a historical perspective the use of oncolytic viruses, including herpesviruses and adenoviruses, which are designed to replicate conditionally in cancer cells. The state of clinical trials in this field is clearly summarized, as are the goals for future research. Jim Markert’s involvement in this realm since its early days with Bob Martuza infuses the chapter with historical and scientific authenticity. “Gene Therapy for Human Malignant Brain Tumors,” by Nikolai Rainov and Huan Ren, describes the use of other viral and nonviral strategies to kill brain tumors. The succinct summary of the clinical trials that have been completed is well worth the read. The book ends with a chapter on neural stem cell biology in brain tumors authored by Evan Snyder and his colleagues. The keen interest in neural stem cell research as it pertains to gliomagenesis as well as glioma treatment infuses this field with excitement and promise. The authors of this chapter have guided this field from its infancy and have seen its explosion. Clinicians as well as basic scientists can appreciate the insights brought to tumor biology and neuro-oncology by this field. The chapter examines some of the experimental paradigms for treatment using neural stem cells and the mechanisms that may underlie their homing capabilities. Many of the mechanisms proposed in the chapter have been demonstrated in recent publications. One aspect of neural stem cells that remains not fully covered in this chapter is the notion of cancer stem cells being isolated from human brain tumors. The possibility that glioblastoma multiforme is a stem cell disease is a compelling notion that may have dramatic ramifications on controlling the genesis as well as improving the treatment of this disease.
Glioblastoma Multiforme offers a discerning and critical view of dynamic fields of research as well as treatment. I recommend it especially to researchers with a specific interest in translation. It will be read with profit by researchers who seriously desire to enrich their minds with aspects of this complex disease in which they are not deeply rooted. Clinicians, including neurosurgeons, neuro-oncologists, radiation oncologists, and allied health professionals, will benefit from a perusal of the research, which clearly is at the threshold of making dramatic inroads into the treatment of this devastating disease.