U Ruther et al (eds)
Published by Karger (2000)
ISBN: 3-8055-71167-X. 362 pages plus index.
As survival times lengthen and overall remission rates increase for patients undergoing organ transplantation treatment or for a large number of malignancies, the potential risk of developing therapy-associated secondary malignancy is becoming an area of increasing concern and attention. Secondary tumours may occur following successful treatment of the primary tumour with chemotherapy, radiotherapy and/or immunosuppressive therapy. Malignancy may also occur following organ transplantation and long-term use of immunosuppressive therapy.
This excellent new book presents information and data in an orderly, readable manner. The early chapters detail basic concepts of tumour biology and discuss some specific carcinogens and mechanisms of action of certain chemotherapeutic agents and immunosuppressants and inductors.
The role of proto-oncogenes and variants of tumour suppression genes is discussed in some detail, as is the role of DNA repair, mutator genes and apoptosis. This discussion is of particular interest for researchers and clinicians alike.
In later chapters, the potentially mutagenic and carcinogenic effects of cytostatic agents commonly used as chemotherapeutic agents are discussed in some detail, as is the tumorogenic effect of radiotherapy.
The role of other “risk” factors for second malignancy is discussed. Individual agents and chemotherapy regimes are examined, as is dosage and method of delivery.
As survival time and remission rates increase, more information is becoming available on rates of “therapy-related” second malignancy, and much work is now being done to study ways of modifying existing protocols to try and minimise the risks of second malignancy.
The detailed chapter on immunosuppression and immunoindicators will be of interest to scientists and clinicians working in the area of organ transplant, and includes a brief discussion of a future where organ transplantation can take place without immunosuppression.
A later chapter focuses on malignancy following organ transplantation, and immuno therapy, immunosurveillance and tumour recognition are the subject of a detailed chapter incorporating an overview of the immune system and general concepts in tumour immunology and surveillance.
A second section of the book focuses on the clinical presentations in a variety of settings: following chemotherapy, radiotherapy, bone marrow and other organ transplantation.
Finally, there is a large section on new therapies including vaccines, surveillance and monitoring of long-term survivors, as well as the role of supportive and cytoprotective therapies and information from clinical experience.
Overall, this book discusses current therapies and how “findings on the underlying processes will lead to innovative changes in existing therapeutic concepts”.
Ongoing surveillance following successful treatment of malignancy or successful transplantation is an increasingly complex and expanding area of medicine.
This book is of particular interest in discussing the basic biologic and genetic factors involved.
Early detection, as these authors point out, is a pre-requisite for successful treatments of secondary neoplasms or those developing during long-term immunosuppressive therapy. Ongoing studies and books such as this are vital to inform the many clinicians in various disciplines involved in this long-term surveillance.