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Cancer in Children. 4th edition. Edited by P A Voute, C Kalifa, A Barratt. (Pp 359; hardback £49.95) Oxford Medical Publications, 1988. ISBN 0 19 262897 6 .
Over the past 24 years since the first edition of this text, paediatric oncology has changed dramatically. For most children with cancer, survival was then uncertain, treatment largely empirical, and the medical profession was not too concerned about late effects—we were only too happy to have anyone in the long term follow up clinic. The revolutionary advance in cytogenetics and molecular genetics, our ever increasing understanding of cellular mechanisms of differentiation andapoptosis, coupled with application of pharmacodynamics and kinetics to protocol design, have all occurred, and have been gradually incorporated into successive editions of this text. Perhaps the greatest irony is that the biggest leap forward in our understanding of cellular mechanisms has occurred in the six years since the 3rd edition of this book, and yet there have been only modest advances in survival for patients with most of the common childhood cancers, at least in the economically developed world. In short, understanding has not yet translated into cure—the cancer cell is a more complex entity than we naively thought a decade ago. Herein lies a problem for a short text aimed to whet the appetite of newcomers to the specialty. It has to be concise, hence didactic, and yet try to contain as much as books several times its size. Forty authors are named for a volume of 347 pages—the motivation for the writers is clearly not financial!
Inevitably, there are troughs and peaks in this text: selected and somewhat biased bibliographies and a tendency to promote partisan concepts of treatment aspects rather than overall concepts and summaries of approaches, particularly in the chapters relating to specific tumours. In such texts is there really a place for specific protocols? Trainees need guidance about different approaches not flow diagrams of the author’s favourite protocol.
Given its relatively modest price and its backing by the International Society of Paediatric Oncology, it will undoubtedly have a wide audience. Earlier editions adorn most book shelves of European oncologists—you can age the person by the edition they have on display. What is difficult to know is the half life of its actual use.
In 1998, the greatest challenges in paediatric oncology are to translate our understanding of cellular mechanisms into more targeted treatment with fewer long term side effects; and to help those in developing countries to share in the advances. To achieve the latter the basic principles of treatment must be teased out and applied.
There is a real conflict between the high technology of the West and having no money to do anything in the developing world. In the next edition, paediatric oncology in the developing world will surely feature more prominently.