Brain, Vol. 123, No. 1, 189-190,
January 2000
© 2000 Oxford University Press
Book reviews |
BRAIN TUMOUR INVASION; BIOLOGICAL, CLINICAL AND THERAPEUTIC CONSIDERATIONS.
.
University Department of Neurosurgery, Institute of Neurology, University College, National Hospital for Neurology and Neurosurgery, London, UK
There is little doubt that diffuse invasion of isolated tumour cells long distances within the brain is the major obstacle to clinical therapy of many types of human malignant brain tumour. This is epitomized by glioblastoma multiforme, where it was recognized as early as the second decade of this century by Dandy that cure through massive surgical resection was doomed to failure. Even complete hemispherectomies failed to produce clinical cures, with tumour invariably recurring in the contralateral hemisphere as a result of widespread diffuse invasion of tumour cells by the time of diagnosis. However, glioblastoma multiforme provides a clinical and biological paradox. The cells from these tumours display all the characteristics of invasive behaviour, the ability to migrate, the expression of proteolytic enzymatic activity which breaks down basement membrane, extravasation into blood vessels and the ability to grow at peripheral sites (at least if experimentally transplanted)—but these tumours very rarely metastasize.
Studies on the biological mechanisms of brain tumour invasion and why these tumours fail to metastasize are now popular areas of research in neuro-oncology, and there are dozens of research groups world-wide who are examining different aspects of this complex and fascinating problem. Under the circumstances, an authoritative review of what is known about this process would be most welcome. The editors have assembled a distinguished group of authors, not all of whom are involved in mainstream neuro-oncology, to review this area of research. This has led to a six-part book, comprising a total of 25 chapters, which covers fundamental aspects of developmental neurobiology, pathological and clinical aspects of malignant brain tumours, model systems for the study of brain tumour invasion in vitro and in vivo, the mechanisms of invasion, new therapeutic strategies and general conclusions. The emphasis is firmly towards glioblastoma multiforme, although there is a single chapter dealing with meningioma invasion. The clinical problems of childhood primitive neuroectodermal tumours, which have a marked propensity for spread within the CNS, are mentioned, but there does not seem to be any experimental work being carried out in this area.
One interesting premise to emerge is that `invasion' and cell proliferation are inextricably linked. Thus the important observation is made that these are mutually exclusive properties; proliferating cells are incapable of invasive behaviour (at least in vitro) whilst cells exhibiting migratory characteristics cannot proliferate. This leads to intriguing therapeutic possibilities; for example, if cells could be driven towards migratory behaviour and away from proliferation, might the presence of a few migratory, but non-dividing cells be sustainable within the brain, assuming that the migratory behaviour was not associated with other, more destructive activities?
There seem to be other important and quite fundamental questions which are not addressed in this book. For example, are all cells within a tumour capable of invasive behaviour, requiring only a cellular switch or a change in environmental conditions to stop cell division and initiate invasive behaviour? Or are only a subset of tumour cells capable of diffuse invasion, a situation similar to that seen in systemic cancers where only a subpopulation of cells have ab initio, or subsequently develop, the potential to form metastases? Is there a particular genotype associated with invasion or is it the result of simply a change in gene expression? Such questions are now being addressed using gene chip array technology.
This is a useful book, and although it is unlikely to be purchased by every clinical or experimental neuro-oncologist, it does go some way towards the authors' stated aims of being the first comprehensive reference devoted to the invasive behaviour of primary brain tumours. There are good reviews on the components of the extracellular matrix and the role of growth factors and their receptors in mediating invasion. However, many of the other chapters are quite short (although even the shortest chapters have sizeable bibliographies) and fall short of the authoritative standard that we might have expected. There is also a tendency to be rather less than critical of the methodology used to examine `invasion' in vitro and in vivo. There are important questions here which need to be answered; for example, which if any of the animal models described are most appropriate for the study of brain tumour invasion or, looking to in vitro models, are co-cultures of human or rodent brain aggregates more or less relevant than in vitro filter well assays?
I suspect that it would have been possible to have a book about half the length and still cover the same ground by using two strategies. The first would be to leave some of the chapters out, for example those on neuronal migration, basic tumour genetics and gene therapy. There is nothing wrong with these chapters, it is just difficult to see the relevance of their contents to the question of brain tumour invasion and there are a number of more comprehensive monographs and more up-to-date review articles available which cover these topics. The second would be the more ruthless wielding and the editorial pen (or pens) to eliminate the marked degree of repetition of material between chapters.
The book was published in 1998, but there are few references after 1996, which rather limits the usefulness of a book that is aimed at summarizing the quickly moving field of neuro-oncology. However, for the non-specialist worker in neuro-oncology who wants a `one-stop' review of this area, albeit somewhat dated, this would plainly be a useful volume. Similarly, students who are taught neuro-oncology at advanced undergraduate or postgraduate level would find this a useful background on which to pin more recent reading. I suspect that those intimately involved in this area will already be aware of most of what is contained within the book.
Notes
Edited by T. Mikkelsen, R. Bjerkvig, O. D. Laerum and M. L. Rosenblum. 1998. Pp. 464. New York: John Wiley & Sons Ltd. Price £64.50. ISBN 0-4711-54520.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||