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Robert F. McLain, Kai-Uwe Lewandrowski, Maurie Markman, Ronald M. Bukowski, Roger Macklis, Edward C. Benzel Humana Press: Totowa, N.J.2006 379 pp. $195.00, 1-58829-074-3.
This comprehensive textbook addresses the interdisciplinary approach needed for combining different modalities in the diagnosis and treatment of patients with spine tumors. It combines views by well-respected medical and radiation oncologists, orthopedic and neurological surgeons, and rehabilitation and pain specialists involved in the treatment of these patients. The book is well organized in 43 small but informative chapters and contains abundant black and white illustrations that highlight its points. It starts with statistical data that point to the prevalence of the problem (an estimated 500,000 patients presenting with spinal metastases each year in the United States with 18,000 patients presenting with spinal cord compression). As detection methods improve and patients with cancer live longer, one would expect that this book will be very appealing to the oncology community.
Although spine cancer is predominantly a clinical entity, there is a substantial amount of basic research (reflected in chapters 2, 3, and 4) on osteolytic bone resorption, angiogenesis, cell adhesion, and invasion, which are part of the metastatic process. Basic principles of chemotherapy (cell cycle kinetics, the Norton-Simon hypothesis) and new targeted therapies (tyrosine kinase inhibitors, monoclonal antibodies) are well described. The book then continues with various chapters on clinical symptomatology, physical examination, radiographic imaging, and laboratory studies. These chapters are extremely useful for all clinicians, from interns to attending physicians. Descriptions of individual cancers then follow, with emphasis on ones that more frequently involve the spine (multiple myeloma, lung and breast cancers). An excellent description of primary tumors of the spine is presented in chapter 21. Newer conformal radio-therapeutic techniques that closely contour the radiation dose around the tumor, and thus limit normal tissue complications while allowing better tumor control (proton beam, 3D conformal photon therapy, IMRT), are presented. The surgical panel then describes advanced techniques that address resection at every segment of the spine, from C1 to the sacrum. The surgical indications, the issues of spinal instability, the perspective on laminectomy and its failure to improve outcomes, and the newer spinal ventral and dorsal fixation methods are described. In addition, en bloc resections are presented together with their limitations. The book then finishes by addressing ethical issues—“when is enough enough” and a “common sense” approach to the cancer patient.
Several topics of some relevance are addressed only superficially in the book, including Pancoast tumors, PET scan, radiosurgery, and new class I evidence on the role of surgery for patients with spinal cord compression. Also, the book includes sporadic descriptions on intradural spinal tumors, which are in many ways (origin, genetics, treatment) different than primary and metastatic extradural tumors, and one might have just excluded them without affecting the quality of the book.
Overall, this book compares favorably with a previous book on spine tumors by Sundaresan, Schmidek, Schiller, and Rosenthal (Tumors of the Spine, Diagnosis and Clinical Management, W.B. Saunders, Philadelphia, 1990) published 16 years ago. Cancer in the Spine is a well-written, comprehensive, and authoritative textbook on spinal tumors that was a pleasure to read, and it is recommended for all practitioners who care for these patients.