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Malignant Liver Tumours.
  1. E R HOWARD

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Malignant Liver Tumours. Edited by P-M Clavien (Pp 363; illustrated; £112.00). USA: Blackwells, 1999. ISBN 0-632-04406-3.

Surgeons, hepatologists, and oncologists involved in the management of malignant tumours of the liver now have a variety of recent books available for reference. Some of these texts are primarily concerned with surgical management, with subsidiary chapters on diagnosis, pathology, and other modes of treatment. Others are written from the point of view of the physician or oncologist. This new book has been edited with a change of emphasis in that it attempts to examine and compare critically all of the current modalities of treatment as well as some of those which may be successful in the future. I was pleased with the emphasis on maintaining the quality of life in patients with incurable disease rather than trying everything to gain a little more survival time, a very important principle for physicians and surgeons dealing with this group of malignancies.

In the preface, Professor Clavien emphasises that the optimal management of this difficult and often complicated group of tumours depends on a multidisciplinary team approach and he has edited the text to integrate the investigatory, surgical, and oncological aspects of treatment. Firm editorial control allows each of the chapters to be read as a complete essay but I found that the book also read well as a sequential text with minimal duplication of material in each of the sections. The up to date nature of the book is well illustrated by an example from the section on gene therapy which gives details of a phase one study, from November 1998, of recombinant p53 adenovirus gene therapy.

The book is based on the experience at Duke University, North Carolina, and approximately one third of the 48 contributors are from that institution. However, European practice is well represented by the 12 contributors from six countries, including the UK, on this side of the Atlantic.

The structure of the chapters is sound and each has a small but useful list of additional reading material which is presented as an addendum with short critical comments on each reference. The main reference lists are comprehensive and up to date.

An introductory section includes chapters on pathology, epidemiology, imaging, and tumour markers. I agree with the authors that the ideal sequence of the investigation of malignant liver tumours remains to be defined and that too many patients receive all possible modalities of imaging as well as a biopsy. They suggest that once the accuracy of the various scanning modalities is decided, it will be possible to reduce the high costs of current investigations. The section on tumour markers is a good critical review of both the value and limitations of the wide range of possible investigations.

The book includes four further main sections. The second section concerns systemic and local therapies such as hepatic artery ligation. This section is well illustrated, as is the remainder of the book, and is followed in the next section by a series of chapters on methods of tumour ablation which include standard liver resection techniques, transplantation, cryoablation, and ethanol injection. Although this is not a book primarily concerned with the details of surgical technique, the important surgical points are described clearly.

The fourth section is an exciting glimpse into the future of gene therapy, immunotherapy, and angiogenesis, and is completed with a clearly written essay on apoptosis (programmed cell death) and its significance in the possible development of new strategies in cancer therapy. The book concludes with a variety of special topics, such as the management of tumours in children, in the elderly, and in pregnancy.

This is a timely book in view of the rapid increase in the numbers of investigations and treatments now available for the management of liver tumours. It provides an excellent introduction to the subject for trainees but at the same time includes enough thoughtful discussion, up to date information, and practical advice to be of use to any general gastroenterologist or liver specialist.

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