30 CLINICAL RADIOLOGY

Book Reviews Brain Tumours. Scientific Basis, Clinical Investigations and

Current Therapy. Edited by D. G. T. Thomas and D. L Graham. Butterworths, London, 1980. 376 pp. £28.

In the years to come this book will have been seen to have been a milestone in the history of neuro-oncology. It is an up-to-date account of the scientific basis, clinical investigation and current therapy of brain turnouts as stated in the subtitle. It deals mainly with primary brain neoplasms. It is packed with a vast amount of correlated information crammed into its 368 pages of text and yet is easy to read. The size is manageable and will slip into one's briefcase for reading on a train journey. The reproduction, printing and quality of paper are excellent. The editors and the authors are each and all to be congratulated on their lucid, informative, stimulating and in some cases exciting accounts of their subjects.

Perspectives in neuro-oncology gives an excellent overview of the incidence and aetiology of brain turnouts in a concise manner. A misprint occurs where it is stated that '49% of all brain tumours are gliomas.' This might do for ' . . . all primary brain tumours . . . . ' This is foUowed by a useful, not too complicated account of growth kinetics of brain turnouts. 'Tissue Culture of Glioma' deserves special mention. Reading this chapter was a refreshing experience. The techniques for setting up tissue cultures are clearly stated with sufficient mention of fine detail to give real insight into the subject. Its value as an aid to histological diagnosis utilising morphol- ogy and cytochemistry and for in vitro testing for drug sensitivity to enable selection of suitable drugs for chemo- therapy is fascinatingly presented. There are informative chapters on 'Animal Models and Virus Induction of Turnouts', 'Chemical Induction of Turnouts', 'Brain Related Antigens', 'Cellular Immune Responsiveness of Patients with Primary Intracranial Neoplasms', 'Humeral Immunity and Glycolysis' with interesting observations on isoenzymes. The chapter on 'Radiation Biology' is an excellent readable account of the primary biophysical events and subsequent cellular and organ effects of radiation. Much of the chapter is a general account of radiation biology and I would have liked to have seen more, specific to CNS. The chapter on 'Mathematical Models of Glioma Growth' presented a clear logic but needs more space to illustrate the workings of the impressive array of differential equations.

The chapter on the 'Clinical Study of Gliomas' was out- standing, and although it is easy to read with a number of extremely useful tables giving one a remarkable insight into the numerous ways of clinical presentation and change in symptomatology with the advance of the disease, it is the sort of chapter that bears reading at least a few times as there will always be something else of interest in it. My only disappointment was that it was only on the last of 26 pages of text that radiotherapy was briefly mentioned. On the second pag e the patients were said to hay6 been treated by two neurosurgeons. I presume that a fair proportion also had radiotherapy to advantage. I would recommend the writings of Arthur E. Jones, H. J. G. Bloom (mentioned briefly as stated above), H. F. Hope-Stone (mentioned briefly as stated above) of Great Britain and Glenn E. Sheline and J. Bouchard of the United States. Apart from the good chapter (16) on radiotherapy and the extremely useful chapter (17) on chemotherapy which incidentally delighted me by being one

of the few publications actually stating that intracranial metastases were far more common than primary intracranial neoplasms (ratio 8:2.5), most writers quote post-mortern figures of 30-50%.

Chapter 13 is a masterly treatise on neuro-radiology, Especially fascinating was the indirect approach essential in this art (and science) of combining clinical information (when adequate) with the various modalities of investigation (plain X-ray skull, CT scan, isotope scan and arteriography, etc.) and a knowledge of pathology in attempting to approxi. mate to the type of tumour the neurosurgeon is likely to encounter at craniotomy and of course as an aid to differen. tial diagnosis from abscess, haematoma, etc. Studies on indium-111 labelled leukocytes which settle in brain abscesses are not mentioned as they were being done at the time of writing this book and not yet published.

An excellent account of pathology is given in relatively few pages with a dynamic picture of the pathological conse. quences by the process of growth. The surgery of gliomas is a lucid and brief account dealing with all essentials. Immune. therapy always looks better than it is but this is an excellent balanced account.

I would have liked to have seen somewhere a mention of Lundberg (plateau or A-) waves and their important impact on the fluctuations of levels of consciousness and neurological deficit. Also a 'Classification of Brain Oedema' by J. D. Miller for example whose work is quoted in the text or the earlier work by I. Klatzo or subsequent work by R. A. Fishman.

Finally this book should be on the shelf of anyone interested in neuro-oncology as it will act as a springboard for future advances in this discipline.

Jeffrey Stone

From 'Quantity of Radiation' and 'Dose' to 'Exposure' and 'Absorbed Dose' - An Historical Review. NCRP Publications, Washington, DC 20014.

This lecture is the fourth in the Lauriston S. Taylor series, and was delivered during the annual meeting of the NCRP on 2 April 1980. The author has been a member of the ICRU for 10 years and is now its chairman. Prior to that he had for five years been Deputy Director of the US Armed Forces Radiation Research Institute, following 20 years with NBS.

In his lecture, Dr Wyckoff traces the development of dosimetric quantities and their units in a direct and very readable manner. There is no mathematics and only three diagrams, all clear and effective. While it may be of most interest to radiation physicists, it will be well worth reading for any radiologist or radiotherapist who stills finds it difficult to distinguish the roentgen and the tad and wishes he didn't. Both the initial dosimetric concepts and the steps needed for their practical realisation are dearly described, and it is illuminating to find how at least the outlines of the roentgen and the rad were formulated in 1908 and 1914 respectively, many years before their international adoption. Dr Wyckoff concludes with a summary of the absolute accuracy now achieved by the major national and international standardising laboratories and considers its adequacy for medical needs.

J. LaW