MALIGNANT TUMORS OF CHILDHOOD Edited by Benjy Frances Brooks, MD University of Texas Press, Austin, 1986. 248 pp.
Just when a spokesman from the Harvard School of Public Health questions that we might not be winning the war against cancer, this book presents in general a more optimistic review of malignant tumors in children. And ironically enough, this reports the proceedings of the Sixth Annual Robert E. Gross Symposium. Robert Gross, himself a Harvard genius, is proposed as perhaps the outstanding American surgeon of the twentieth century and the inspiring teacher of many of the participants in the seminar. Each year a Gross disciple is honored, and this year the recipient was Dr. Judson Randolph, professor of surgery at George Washington University and Surgeon- in-Chief of the National Children's Hospital in Washington, OC.
Surgical conditions are discussed in breadth and depth, with review of old and new concepts. These include where possible, etiology, prognosis, various therapies, immunologie characteristics of disease, medical and surgical approaches, and epidemiology. Throughout the book a pluralistic approach to malignancies is promoted. While care at a tertiary center is recommended because it should involve surgeon, immunologist, oncologist, radiologist, pathologist, social worker, and child life agent, omitted is the primary referring pediatrician who not only cares for episodic disease but also serves as the child's "health home." Many unanswered questions are presented which mandate continued cooperative research at several tertiary centers.
Numerous cases are presented to show how progress is being made, but also to demonstrate that two similar patients may respond differently to the same treatment. One is impressed with the tremendous volume of research in progress and the presentation of vast amounts of facts and figures. Of interest in evaluating diagnoses and therapies are the new modalities, such as use of CT and bone scanners, ultrasound, digital subtraction angiography, magnetic resonance imaging. The use of multiagent chemotherapies is encouraging along with the discovery of new medicines that have not been released for general use.
One cannot select which of the 34 papers is most exciting. One chapter concerns malnutrition's contribution to poor prognosis and predisposition to infection. Success with treatment of Wilms' tumors and leukemia is encouraging, whereas therapy of neuroblastomas after two years of age leaves much to be desired. While the book does not presume to be a complete text on pediatrie oncology, it lacks an index. The papers are followed by good references. Malignant Tumors of Childhood provides a good resume of the state of the art and one looks forward to the report of next year's symposium.