R Pollack (ed)
This is one of a series of Atlases of Clinical Oncology published by the American Cancer Society. Its editor is Dr Raphael Pollock, Chairman of Surgical Oncology at MD Anderson Cancer Center in Houston.
This is a handsome text, lavishly illustrated and beautifully presented. It is comprehensive with chapters on epidemiology, pathology, imaging, biopsy and staging and prognosis followed by sections on various anatomical sites. There are then chapters covering topics such as radiotherapy, chemotherapy, metastasis, local recurrence and rehabilitation.
There is extensive coverage of the common and uncommon sites and types of sarcoma. In addition, there is good coverage of the borderline pathologies such as atypical lipomata that frequently give rise to confusion. The chapter on radical amputations is welcome – these procedures are rarely performed, but must be in the armamentarium of the surgical oncologist caring for patients with sarcoma. Recent developments in the molecular biology and pharmacology are included, but will necessarily become dated quickly.
Most of the authors are faculty members and the institutional approach of the MDACC is apparent, with many references to investigational institutional protocols. Discussion of pre- versus post-operative EBRT reveals a similar institutional influence.
As with most multi-author texts, there is repetition and variability between chapters. The advantage is that each of the sections stands alone and can be used as a reference, but the depth of coverage of the topics varies, and the message is not always consistent.
Selection of what should be included in a text and to what depth is always challenging. There are some inconsistencies in the choices, such as the 21 pages on extremity sarcomas and 26 pages on head and neck sarcomas. The important issues are well-covered, although areas such as the surgical strategy for retroperitoneal sarcoma need more emphasis.
The imaging section is disappointing. There is a very technical discussion of MRI techniques followed by presentation of many images. Unfortunately the resolution is variable, and the labeling of images is sparse. Inclusion of images of the common differential diagnoses that may be confused with sarcoma is vital in this type of work.
The important issues of screening for recurrence needs better editing. The chapter on imaging suggests that surveillance MR should be done three to six monthly. The section on staging and prognosis points out that local recurrence does not influence overall survival, and the section on extremity sarcoma reports that almost all recurrences are detected clinically, throwing doubt on the need for any routine follow-up imaging.
This is an excellent book for advanced surgical trainees with an interest in surgical oncology. Surgical oncologists will find it useful as a reference when encountering less common lesions. At $323 it is unlikely that general surgeons or orthopaedic surgeons without a specific interest could justify the cost. It makes an excellent addition to a surgical library. It comes with a CD-ROM for easy reference and for preparation of lectures.
Department of Surgery
The Royal Melbourne Hospital, VIC