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This monograph presents a useful review of a diffi cult area of clinical neurology. Primary brain tumours are fortunately fairly rare with about 2500 new cases a year. being recorded in the United Kingdom. The term “cerebral gliomas”, by custom, encompasses all tumours of central neuroepithelial origin. This is a rather more general definition than limiting it to those clearly arising from the neuroglia. It is a useful approximation as the treatments vary little. The complexities of pathological classification are well summarised in a chapter by Collins. This well indicates the evolving nature of cell type identification as new irnmunocytochemical techniques are developed but some more detailed indication of the sensitivity of such techniques to tissue fixation would have been useful.
There is little definite known about epidemiological links apart from certain rare genetic predispositions and a few environmental risk factors such as ionising radiation. Of current interest is the public health concern about electromagnetic fields from power lines and mobile phones. These are all usefully discussed in the opening chapter but without definitive conclusions.
Related advances in molecular and cell biology are well covered in two chapters largely devoted to relevant tumour suppressor genes and growth factors. These and a further chapter on gene therapy provide hope rather than promise for useful new therapies. In particular strategies to block angiogenesis and the development of antisense oligonucleouides which will selectively block RNA transcription are being investigated. However, the same problems remain, as with techniques based on gene transfection by various virus vectors, of ensuring adequate exposure of all viable tumour cells to the agents. Despite this some promising initial studies are recorded.
The more conventional therapies of surgery, radiotherapy, and chemotherapy are covered in three comprehensive chapters which well summarise the current situation. Whereas the usefulness of surgery and radiotherapy is established, there is still a lack of really effective agents for chemotherapy. It is sad to relate that even in this decade it is clear that much more definitive assessments of efficacy could be made if there was more general participation in randomised multicentre studies such as those of the MRC, EORTC and RTOG.
The final chapter discusses the assessment of quality of life. For some patients treatment may be successful, but for others it may be just an additional terminal burden for them and their families. Progressive disease and treatment may produce focal and diffuse defects which are both functional and neurobehavioural. Careful assessments of these changes by established instruments is important, particularly in the context of clinical trial. This chapter presents a useful introduction to the subject.
This small volume contains a wealth of relevant information. It is extensively referenced and although multiauthored, maintains a high standard throughout. It is strongly recommended.
For details of the BNPA, which is open to psychiatrists, psychologists, neurologists, and those in related fields, please contact Dr Jonathan Bird, Secretary BNPA, Burden Neurological Hospital, Stoke Lane, Stapleton, Bristol BS16 1QT.
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