Kim DG, Lundsford LD, eds. Current and Future Management of Brain Metastasis. Karger; 2012; 308 pages; $233.00.
The development of brain metastases has been the most feared complication of systemic cancer. In the past, once this complication occurred, all hope disappeared: the patient was considered to be terminal, and treatment efforts palliative. To improve the quality of life of cancer patients requires a thoughtful approach to the treatment of brain metastases and the development of new treatment options. For many years the standard therapy for metastatic brain tumors has been whole brain radiation therapy (WBRT), with surgical resection reserved for the few patients with limited systemic disease with single lesions in surgically accessible locations. The result of this limited approach has been disappointing and has the potential to cause significant morbidity. This has been the reason for the poor quality of life of the cancer patient with brain metastases and the lack of optimism. Although any systemic cancer has the potential to metastasize to the brain, tumors from lung and breast and malignant melanoma have the greatest propensity to do so and account for a large number of the 170,000 new cases of metastatic brain tumors in the United States yearly. The scope of this complication in oncology is tremendous.
An appreciation of this background is important to understand the impact of new developments in the treatment for metastatic brain tumors. Although improvements in neurosurgical techniques, delivery of WBRT, and the development of chemotherapy, immunotherapy, and, more recently, targeted therapy may all be listed as therapies improving the treatment of brain metastases, stereotactic radiosurgery (SRS), without question, has been the most important advancement to improve survival and quality of life for the cancer patient with brain metastases. The series Progress in Neurological Surgery published by Karger recognizes topics of interest in neurosurgery and invites editors of international reputation to personalize the topic by editing a volume of multi-authored chapters from authoritative specialists throughout the world. Since the series began in 1966, several editions have been dedicated to the various neurosurgical aspects of brain metastases. The most recent publication in this series, volume 25, entitled Current and Future Management of Brain Metastasis, addresses the challenges of brain tumor management with a focus on SRS. The volume editors, Dong Gyu Kim from Seoul and L. Dade Lunsford from Pittsburgh, have created a new addition to the series that provides a wealth of information from specialists around the globe regarding the role of SRS in the management of brain metastases, framed by a more general presentation of brain metastases management.
The publication is divided into five sections. The first section includes a general overview of brain metastases from a historical and epidemiological perspective, in the first two chapters, and then moves directly toward the emphasis of SRS with two separate chapters on pathophysiology and radiobiological principles of SRS. The second section is comprised of seven chapters that serve the purpose of providing a review of the various treatment modalities, including surgery, WBRT, chemotherapy, and SRS. This section appropriately begins with a chapter discussing the various diagnostic issues of neuroimaging of brain metastases. The placement and detail of this 18-page chapter from The University of California in San Francisco recognizes that the diagnostic issues are as important as the therapeutic issues in the treatment strategy of brain metastases. Choosing specialists from this institution to discuss this topic reflects the thoughtfulness of the editors in gathering the specialists with the most depth of thought and experience in each particular topic. Although this particular example is provided, each chapter is similar with the “best of the best,” discussing one particular area of expertise with clarity. And though this section is meant to provide a general review, two of seven chapters focus on SRS. This section paves the way for the third section, which contains eleven chapters pertaining to the most important issues regarding SRS in the management of brain metastases. The third section entitled “Radiosurgery” is the centerpiece of the volume. The various chapters review, in explicit detail, the various SRS issues that are pertinent to patient management, including SRS dosing; treatment of specific tumor types such as lung, breast, renal cell, and melanoma; adverse effects of SRS; and combining SRS with surgical resection and WBRT. Although the chapters before and after this section provide depth to this volume, the chapters within this section provide the detail that will make this volume invaluable to specialists performing SRS, usually neurosurgeons and radiation oncologists. The overall selection of topics, quality of images, content of information, and clarity of presentation make this volume a useful reference for neuroradiologists, neuro-oncologists, medical oncologists, and neuropathologists. The fourth section builds on the clinical emphasis of this volume by presenting three chapters that address difficult clinical issues for SRS, including management of large tumors, multiple tumors, and recurrent tumors. The volume ends with a single chapter section reflecting on the future of management, with an emphasis on SRS.
This volume is a treasure for anyone involved with SRS. The organization, content, images, and references are consistent and of the best quality throughout the publication. This is not an easy accomplishment in a worldwide multi-authored publication, but reflects the thoughtfulness, expertise, and diligence of the editors and all of the contributors. The neuroradiologist plays an important role in the management of brain metastases. Although the neuroradiologist is not directly involved with performing SRS, the neuroradiologist provides diagnostic information regarding initial diagnosis and is crucial in differentiating necrosis versus recurrence in the treated patient. Therefore, it is essential for the neuroradiologist to have a firm understanding of SRS, and this volume provides such a reference for all of the reasons discussed. There are other similar publications that have attempted to provide an overview of SRS, but this volume is outstanding. Full of pertinent information, this book is to-the-point and easy to follow. The references at the end of each chapter are carefully selected by each author and provide an excellent resource for the reader. The references represent the most comprehensive scholarly publications available regarding the topics covered in each chapter. The only criticism is that the title of this volume is perhaps somewhat misleading in that the physician may find the detailed emphasis on SRS overwhelming in contrast to the overview of other therapeutic modalities in the treatment armamentarium of metastatic brain tumors. Such a reader may be therefore critical of not finding the equivalent depth of coverage for all modalities, thereby missing the rich wealth of information and experience regarding SRS and the major role this development plays to improve the survival and quality of life for patients inflicted with metastatic brain tumors.