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Paediatric Oncology. Clinical Practice and Controversies.
  1. J S LILLEYMAN, Professor of paediatric oncology

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    Paediatric Oncology. Clinical Practice and Controversies. 2nd Ed. Edited by C R Pinkerton and P N Plowman. (Pp 799; £135 hardback.) Chapman and Hall Medical, 1997. ISBN 0-412-63080-X.

    American textbooks contain few citations to articles published outside the United States, a form of literary chauvinism that sometimes denies the reader a balanced view of the world, so it is pleasing to see that by recruiting authors almost exclusively from Europe, Ross Pinkerton and Nick Plowman have produced an alternative to the big American texts rather than a competitor.

    Like any multiauthor effort it has its good and its not so good sections, but there are some real gems. Charles Stiller’s essay on epidemiology is a model, and his graph showing the rising number of survivors of childhood cancer will be flagrantly copied and projected at meetings for years to come. Chris Mitchell and Kathy Pritchard-Jones do an excellent job of making tumour suppressor genes and the like understandable, even for those who (like me) do not know one end of a Southern blot from the other.

    The main tumour-by-tumour section is good and sufficiently well referenced to get an interested reader quickly into the core literature, and the problem of how to cope with rare and strange tumours that do not fit elsewhere is neatly despatched by Nick Plowman in a “stamp collectors’” chapter which he must have enjoyed writing as much as I enjoyed reading. The book is adequately up-to-date with citations to articles up to late 1995, particularly important in chapters dealing with treatment.

    The section covering supportive treatment is fine as far as it goes, but is relatively perfunctory for what consumes most of the resources in children’s cancer units and where prejudice abounds. While paediatric oncologists may agree on collaborative protocols for chemotherapy or radiotherapy, there is considerable variability in all other aspects of treatment— intravenous access, prevention of infection, dietary advice, antibiotic regimens, and the like. Many of the discrepancies between centres are clinically unimportant, but they are a common source of worry for parents if their children are treated differently at different hospitals. Books like this don’t help if they offer guidance which appears as dogma, and there is an appendix at the back—practical guideline tables—where arguably this is so. It describes what antibiotics to choose, what dose and frequency and so on, and in so doing oversimplifies. Inexperienced readers may have difficulty reconciling what they read with what they see in practice, and with what they may be taught in any particular unit.

    My only other negative feelings are predictable as I am a haematologist. The business of the pathology and classification of the leukaemias is ours, not that of morbid anatomists. Fair’s fair. More importantly, in future editions (I say this confident that there will be future editions), as blood products are probably the most dangerous drugs oncologists will ever prescribe, and as their use and complexity is increasing, perhaps the editors could give transfusion medicine a section of its own. If something has to go to make room I would be happy to make suggestions.