Rohan Ramakrishna - Central Nervous System Metastases: Diagnosis and Treatment

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The editors and authors are to be congratulated for organizing this comprehensive, multidisciplinary text reviewing the contemporary management of brain and spinal metastasis. They draw upon the breadth of experience from an international group of authors while still integrating epidemiology and basic biology with diagnosis, evaluation, and treatment. All aspects of metastatic disease including local control, leptomeningeal disease, paraneoplastic syndromes, and neurocognitive implications are reviewed. Beyond standard care, alternative and complimentary therapies are also reviewed in relation to their impact on quality-of-life issues, neurocognition, and pain control.

Advances in our biological understanding of radiation, new technologies, and combinational therapies have transformed our approach toward central nervous system metastasis. Recent data supporting the synergistic effects of radiation therapy and immunotherapy has modified the treatment paradigms used. This text provides a framework for understanding the biology of radiation therapy as it relates to the multiple technological choices available to the treating physician. The authors also provide a detailed perspective of the specific advantages and disadvantages of the multiple radiation therapies available. New technologies are reviewed from the perspective of maximizing efficacy and minimizing toxicity, independently and as combinatorial therapy. The newest advances in radiation therapy which maximize the tumoricidal effect while minimizing neurocognitive decline are clearly reviewed in concise prose.

Management of metastatic disease requires the integrated efforts of surgeons, oncologists, neuro-oncologists, neurologists, radiation oncologists, pathologists, precision medicine, imaging specialists, neuropsychologists, neuro-psycho-pharmacologists, and social workers. A complex disease management team applying the newest medical, surgical, and technological tools to alleviate this devastating oncologic process is required to work in conjunction with cognitive experts in order to maximize the quality of life and maintain family stability. This book does an excellent job of tying all of these facets together in order to give the reader a clear and concise treatment paradigm. The complexity in managing metastatic disease is not only biological but also psychosocial. The authors emphasize the importance of integrating all aspects of cancer care for our patients.

I strongly recommendCentral Nervous System Metastases: Diagnosis and Treatmentto all practitioners in this arena. Being the first text of its kind, it is really a must have for the serious student and caregiver. Students, nurses, physicians, psychologists, physicians, psychologists, social workers, and psychiatrists will all find value in digesting components of this book. Management of metastatic tumors requires both scientific and emotional tools emphasized by the authors.

We live in an interesting time as we treat patients with central nervous system metastases. Though systemic therapies have become more successful and diverse, the number of patients with central nervous system metastases is growing. Furthermore, patients are living longer with CNS metastatic disease. As such, it is imperative in the modern era that patients with CNS metastases are treated in a holistic, multidisciplinary fashion. Our goals as treating physicians can no longer be singularly focused on the local control of a CNS lesion. Rather, we must consider not only oncologic control but also quality of life, the interaction of our treatments with systemic therapies, pain control, and much more.

With that in mind, we have endeavored to produce a multi-specialty book on the diagnosis, evaluation, and treatment of CNS metastases of the brain and spine. Our authors span the globe and are noted experts in their fields. We have chosen authors who bring unique perspectives to the field of CNS metastases and hope that you find their contributions both educational and useful.

As you will see, we have designed this book to cover what we consider essential contemporary topics in CNS metastases care. Truly, a book like this would have not have been particularly interesting even 10 years ago given the subsequent advancements in systemic and targeted therapy, radiation therapy, and surgical therapy. In general, we have begun each section with chapters covering the fundamental biology of disease so that subsequent chapters on imaging, diagnosis, and treatment can be properly contextualized.