The Gliomas, 1e

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9780721648255: The Gliomas, 1e
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Provides up-to-date information on the variety of complex, diagnostic and therapeutic modalities available to neurosurgeons and oncologists today! Topics include epidemiology, pathology, preoperative management, neuroanesthesia, biopsy methods, intraoperative tumor localization, ICU care, pain management, chemotherapy, immunotherapy, and more.

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About the Author:

Mitchel S. Berger M.D., F.A.C.S., F.A.A.N.S. is the Berthold and Belle N. Guggenhime Professor and Chairman of the Department of Neurological Surgery at the University of California, San Francisco (UCSF), and is an expert in the fields of neurosurgery and neuro-oncology. He also serves as Director of UCSF’s Brain Tumor Research Center.

After graduating from Harvard University in 1974, Dr. Berger earned his medical degree from the University of Miami School of Medicine. He completed a clinical fellowship in neuro-oncology at UCSF, a fellowship in pediatric neurosurgery at the Hospital for Sick Children of the University of Toronto, and his neurosurgical residency at UCSF. In 1986, he became Assistant Professor of Neurosurgery at the University of Washington School of Medicine, after which he was named Associate Professor (1990) and Professor (1996).

Dr. Berger has clinical expertise in treating adult and pediatric brain and spinal cord tumors. He is a pioneer of intraoperative brain mapping - a technique used to avoid functional areas of the brain during surgical resection of a tumor. His work has enabled surgeons to perform more extensive resection of tumor with less chance of producing sensorimotor or language deficit.

Dr. Berger is a leader of translational research and is the Principal Investigator of the UCSF Brain Tumor Research Center’s Specialized Program of Research Excellence in neuro-oncology, funded by the National Cancer Institute. His specific research interests lie in identifying molecular markers related to the progression and prognosis of glial tumors, as well as the development of small-molecule therapeutic agents that can be administered directly to the brain via convection-enhanced drug delivery.

During his distinguished career, Dr. Berger has served as President of the American Association of Neurological Surgeons, President of the Society of Neuro-Oncology, President of the North Pacific Society of Neurology, and Vice President of the Congress of Neurological Surgeons. He has also been a director of the American Board of Neurological Surgery and a member of the Board of Directors of the American Association of Neurological Surgeons. He is currently President of the American Academy of Neurological Surgery.

In 2009, Dr. Berger was awarded the prestigious Winn Prize by the Society for Neurological Surgery. He currently serves as a member of the National Football League Head, Neck and Spine Committee, focusing on retired players’ issues and examining the consequences of repetitive head injury and concussion. He is also an active member of numerous professional organizations, including the American Organization for Cancer Research, the American College of Surgeons, and the World Federation of Neurosurgical Societies.

A prolific author, Dr. Berger has contributed over 500 scientific articles to peer-reviewed journals, has edited 6 textbooks, and has written over 80 chapters on various neurosurgical topics. He is currently on the editorial boards of several leading journals including Neuro-Oncology and Neurosurgery.

From The New England Journal of Medicine:

The gliomas are a family of neoplasms that are thought to arise from astrocytes, oligodendrocytes, ependymal cells, or their precursors -- the major nonneuronal cellular constituents of the central nervous system. In children and adults, gliomas constitute approximately two thirds of all primary brain tumors, and each year in the United States 20,000 patients are given a diagnosis of a glial neoplasm. Pilocytic astrocytomas, ependymomas, variants of astrocytomas (e.g., pleomorphic xanthoastrocytomas), and gliomas of the brain stem predominate in children, whereas fibrillary astrocytomas and oligodendrogliomas of the cerebral hemispheres and glioblastoma multiforme are the common glial tumors in adults.

Although gliomas are seldom staged -- in this respect they differ from systemic cancers -- many types are graded histologically, which is useful in predicting tumor aggressiveness and guiding therapy. Some types of glioma can be cured by surgical resection, including, for example, pilocytic astrocytomas of the cerebellum and gangliogliomas. For most types, however, removal and local radiotherapy are helpful, not curative, and only diencephalic gliomas in children and oligodendrogliomas in adults are predictably sensitive to chemotherapy. Moreover, most types recur and become increasingly aggressive as they accumulate predictable genetic alterations.

Enter The Gliomas, the first bench-to-bedside textbook on the glial neoplasms, written by Berger, Wilson, and a distinguished group of contributors. Virtually all aspects of the care of patients and of research are reviewed in this book. Sections 1 and 2 contain valuable discussions of cytogenetic and molecular genetic derangements that occur in gliomas, growth-signal pathways in glial neoplasms as targets for new therapies, the blood-brain barrier as it relates to drug delivery, and gene therapies for glioma. I especially liked the chapter on angiogenesis, which is both a process and a therapeutic opportunity in glial neoplasms. Section 3 provides an up-to-date review of the pathological and immunopathological features of gliomas in children and adults. Section 4, on diagnostic imaging, is richly illustrated, and it provides a thorough review of modern imaging techniques, including magnetic resonance imaging, positron-emission tomography, and single-photon-emission computed tomography.

Sections 5 and 6 will be appreciated by neurosurgeons, since these sections focus on preoperative management and strategies for resection and include a discussion of the role of functional brain imaging in the management of glial tumors. The principles and practice of modern radiotherapy and various aspects of chemotherapy are reviewed in section 7; sections 8 and 9 summarize special topics and complications of therapies for glioma and include chapters on the management of glial tumors in infants and the prevention and management of deep-vein thrombosis and pulmonary embolism in patients with gliomas.

As is the case with most multiauthored books, especially first editions, some chapters of this book have been prepared in greater depth than others, and there are inevitable inconsistencies and duplications, as well as some omissions. For example, the recent increase in the rate of diagnosis of glioblastoma multiforme in the elderly is attributed in one chapter to the widespread availability of neuroimaging devices in the 1990s as compared with the 1970s and to better medical care for elderly patients; in the following chapter, the increase is said to be a true increase in incidence, probably as a consequence of environmental toxins. Neither contributor seemed aware of the other's interpretation of the data, and they apparently came to radically different conclusions on this important public health issue. Repetition is unavoidable in multiauthored books, but minor reorganization and further editing will enhance the second edition of The Gliomas.

I was surprised that the section on basic science did not include a chapter on stem-cell biology, an exciting area of basic neuroscience that may be highly relevant to the genesis of glial tumors. The genes that control the development of the brain may be of great interest to tomorrow's neuro-oncologists. Finally, I was disappointed that the book did not include a discussion of the merits and shortcomings of adjuvant chemotherapy for the treatment of malignant gliomas in adults, a topic that has preoccupied the field for three decades. Studies of adjuvant chemotherapy have contributed enormously to our understanding of prognostic factors in glioma and have taught us a great deal about the design and conduct of clinical trials in neuro-oncology.

We are entering an exciting time in neuro-oncology, because advances in anatomical and functional neuroimaging, human molecular genetics, and related fields are leading to safer, more complete surgical resection, safer conformal radiotherapy, the possibility of predicting the sensitivity of tumors to existing chemotherapies, and, for the first time, a fundamental understanding of the glial neoplasms, so that drugs with novel mechanisms of action can not only be imagined but also be designed. The Gliomas will be a valuable reference for scientists, oncologists, and trainees studying cancers of the central nervous system. It will be featured prominently in many libraries because it is a comprehensive and authoritative textbook and because it captures the excitement and complexity of neuro-oncology, a discipline that is coming of age both scientifically and clinically.

Reviewed by J. Gregory Cairncross, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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