Cancer in the Spine: Comprehensive Care
http://www.100md.com
《新英格兰医药杂志》
"When a plant goes to seed, its seeds are carried in all directions; but they can only live and grow if they fall on congenial soil." This analogy, in an article by the English surgeon Steven Paget published in the Lancet in 1889, was an attempt to explain the predilection of certain types of cancer to spread to bone and other tissues. More than a century later, the "seed and soil" theory is still being debated, and the discourse has expanded to include the biologic effect that the seed has on the soil after implantation. In an early chapter of this book, Cancer in the Spine, David G. Hicks outlines what is known about the biology of metastatic disease. In addition to the "congenial" environment of the spine, regional venous drainage, angiogenesis, cell adhesion, and growth factors are all responsible for disseminating tumor cells. One of the initial steps in metastasis to bone is the stimulation of osteoclastic resorption. The resultant osteolysis is responsible for many of the clinical sequelae of metastatic disease — bone pain, pathologic fractures, spinal deformity, and spinal cord compression. The recognition of these molecular mechanisms has led to new forms of treatment, including bisphosphonate therapy, to inhibit the activity of osteoclasts.
Approximately 500,000 patients present with spinal metastases each year, and symptomatic spinal cord compression will develop in nearly 20,000 of them. Improved cancer-survival rates, combined with an aging population, will increase the prevalence of spinal metastases in the future. Major advances in the diagnosis and treatment of spinal neoplasms have led to an improved quality of life for these patients and to cures for the small group of patients with primary spinal malignant tumors.
Interdisciplinary collaboration is the key to managing the care of patients with spinal tumors. Treatment often involves multiple methods, including chemotherapy, radiation therapy, and surgery. The editor of this book, Robert F. McLain, has assembled an excellent resource for practitioners and students of all the disciplines involved in the care of patients with cancer of the spine. Although the book does not delve sufficiently into detail to serve as a stand-alone resource for any specialty, it does an excellent job of providing an overview of the field. Readers will gain an appreciation of numerous treatment options and an understanding of how they relate to one another. The book has clinically relevant chapters on pathophysiology and a section on the diagnostic evaluation of spinal tumors. The types of primary tumors that most commonly spread to bone are discussed in separate chapters and followed by a section in which each treatment method is discussed individually. One of the final chapters includes a helpful list of clinical practice guidelines for cancer surveillance and screening after initial treatment. The book ends with a cogent discussion by Edward C. Benzel and others, entitled "When Is Enough, Enough?" in which hospice care and the role of palliative surgery are discussed. The authors stress the importance of multidisciplinary collaboration and the involvement of the patient and his or her family in the complex and emotionally charged decision-making process.
I do not find fault with anything about this book. McLain practices at the Cleveland Clinic Foundation, as do 4 of the 5 section editors and 33 of the 65 contributors. Although having contributions by so many persons from one institution could be seen as detracting from the book, each chapter is well referenced, the recommendations are evidence based, and there is no hint of institutional bias. The book is also balanced, with excellent chapters by authors from other high-quality institutions, including the Memorial Sloan-Kettering Cancer Center, Massachusetts General Hospital, the University of Texas M.D. Anderson Cancer Center, Johns Hopkins University, and others. Cancer in the Spine is a compact gem of succinct chapters that provide a multidisciplinary overview of this complex topic.
Bradford L. Currier, M.D.
Mayo Clinic
Rochester, MN 55905((Current Clinical Oncolog)
Approximately 500,000 patients present with spinal metastases each year, and symptomatic spinal cord compression will develop in nearly 20,000 of them. Improved cancer-survival rates, combined with an aging population, will increase the prevalence of spinal metastases in the future. Major advances in the diagnosis and treatment of spinal neoplasms have led to an improved quality of life for these patients and to cures for the small group of patients with primary spinal malignant tumors.
Interdisciplinary collaboration is the key to managing the care of patients with spinal tumors. Treatment often involves multiple methods, including chemotherapy, radiation therapy, and surgery. The editor of this book, Robert F. McLain, has assembled an excellent resource for practitioners and students of all the disciplines involved in the care of patients with cancer of the spine. Although the book does not delve sufficiently into detail to serve as a stand-alone resource for any specialty, it does an excellent job of providing an overview of the field. Readers will gain an appreciation of numerous treatment options and an understanding of how they relate to one another. The book has clinically relevant chapters on pathophysiology and a section on the diagnostic evaluation of spinal tumors. The types of primary tumors that most commonly spread to bone are discussed in separate chapters and followed by a section in which each treatment method is discussed individually. One of the final chapters includes a helpful list of clinical practice guidelines for cancer surveillance and screening after initial treatment. The book ends with a cogent discussion by Edward C. Benzel and others, entitled "When Is Enough, Enough?" in which hospice care and the role of palliative surgery are discussed. The authors stress the importance of multidisciplinary collaboration and the involvement of the patient and his or her family in the complex and emotionally charged decision-making process.
I do not find fault with anything about this book. McLain practices at the Cleveland Clinic Foundation, as do 4 of the 5 section editors and 33 of the 65 contributors. Although having contributions by so many persons from one institution could be seen as detracting from the book, each chapter is well referenced, the recommendations are evidence based, and there is no hint of institutional bias. The book is also balanced, with excellent chapters by authors from other high-quality institutions, including the Memorial Sloan-Kettering Cancer Center, Massachusetts General Hospital, the University of Texas M.D. Anderson Cancer Center, Johns Hopkins University, and others. Cancer in the Spine is a compact gem of succinct chapters that provide a multidisciplinary overview of this complex topic.
Bradford L. Currier, M.D.
Mayo Clinic
Rochester, MN 55905((Current Clinical Oncolog)