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Neoplastic Diseases of Childhood.
  1. MICHAEL C G STEVENS, Consultant paediatric oncologist

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    Neoplastic Diseases of Childhood. Vols 1 and 2. Edited by Carl Pocheldy. (Pp 1603; £280 hardback.) Harwood Academic Publishers, 1995. ISBN 3-7186-5340-0 .

    Two volumes, 1600 pages (more pages than newly diagnosed children with cancer each year in the UK!) 83 chapters, and 114 contributing authors. This represents a substantial project with a wide ranging intention: ‘a useful reference for the clinician and the clinical investigator as well as medical students, residents and fellows’. In his introduction, the editor states his intention to make the text ‘truly international’ although fewer than 25% of the authors actually come from outside North America. There are some big names but not all necessarily writing on the subjects one might expect. Most of the chapter headings are logical and worthwhile, with some exceptions—a whole chapter on the ‘techniques of bone marrow biopsy’ seemed a bit over the top.

    How does one review a 1600 page book in any kind of meaningful way. I am afraid I confess that I did not read every page! I thought I should start by reviewing the bits I thought I knew and then go on to look at the bits I really ought to know more about, before testing the text by looking up some real minutiae.

    I looked first at the chapter on rhabdomyosarcoma and, for a soft tissue sarcoma ‘afficionado’, a worthwhile debate on the diagnostic features (and prognostic value) of alveolar rhabdomyosarcoma would make useful reading. In fact this is covered well and the more recent references would not have been available when this book was published in 1994 (and two years can be a long time in molecular pathology). My suspicions that the data about treatment strategies would focus on North America were confirmed and I was disappointed that important philosophical differences in approach were not mentioned. Part of the editor’s responsibility is to ensure that such balance is present and the North American bias was apparent in other areas as well. The accompanying chapter on ‘Other soft tissue sarcoma’ was disappointing. It was more a catalogue of typical information than an opportunity to explore new approaches to treatment or any attempt to reclassify these difficult tumours by response to chemotherapy. There was almost nothing said about fibromatosis, and desmoid tumour did not even get as far as the index. Disappointing, yes, but was I being unfair? Probably, because there is much useful information about all major tumour types in this book but the text frequently presents details of clinical trial outcomes without adequate explanation or interpretation. Biology and pathology are generally well represented. Brain tumours were particularly comprehensively described but again some areas had just not kept up with the pace of clinical practice. This almost certainly reflects the time required to prepare a text of this length rather than poor authorship.

    In looking at areas I thought I ought to know more about, I was interested to read the chapter on retinoblastoma. I was disappointed. The discussion on the molecular genetics was surprisingly brief and none of the references quoted was dated later than 1987. Cancer biology is a fast moving field but the authors could have made more effort here. The use of chemotherapy in management was similarly out dated with references quoted only from the early 1980s. This was really not good enough. Again, perhaps the firmness of an editorial hand was the missing factor.

    As far as ‘hens teeth’ go, this text was as good as many. Much depends on the structure of the index in searching for the bizarre. In this case the index was well constructed and designed to be easy on the eye. In fact it was sometimes over detailed (20 subheadings for enteral nutrition seemed a bit excessive!). The balance of content was satisfactorily distributed between the general and the specific. It was good to see chapters on pain control, ethical issues, and self help groups. Nutrition was given some prominence, rightly in my view, although I did not agree with its approach or many of its recommendations. Home total parenteral nutrition is almost unheard of in paediatric oncology in the UK but seems to be big business in the United States—is this really justified? Late effects issues are spread out in the text and can be found in individual tumour sections as well as some specific chapters but this can make it hard to get an overview. Late effects are, after all, treatment rather than disease related and this approach also leads to some duplications.

    There have been at least two other major texts in paediatric oncology published in the last five or six years so how does this book compare? By reviewing a book published in 1994 and probably written two years earlier, it cannot possibly appear ‘state of the art’ but its basic content is reliable if not truly as international as was intended. There are however plenty of good illustrations, the overall presentation is attractive and the index is useful. Personally I am not sure that this is the best of the major texts available but it is a worthy contributor to the field. At £280 it is scarcely going to be in any resident or fellow’s personal book collection, (unless, of course, they have a very generous boss!).