But the survival rate is only part of this remarkable story. Eyes that would have been enucleated in the 1960s are now being saved, often with useful vision. And many of the side effects of treatment, such as dry eye, radiation retinopathy, second cancers, and even trilateral retinoblastoma, are rare today, thanks in part to chemotherapy. Even cosmesis has been improved. In patients in whom an eye has been enucleated, it is often difficult to tell which is the prosthesis and which is the real eye.

This progress is detailed in 36 chapters of this comprehensive book, covering retinoblastoma from a historical perspective through methods of treatment, genetic counseling, differential diagnosis, prenatal testing, and future trends. There are over 340 illustrations, of which more than 320 are in color. The authors are to be congratulated. Retinoblastoma will be an asset to ophthalmology libraries worldwide and will be especially invaluable for those dealing with pediatric eye disorders.

With regard to cancer, generally, it is well known that retinoblastoma has been a model for dominantly heritable cancers. It was the first cancer whose gene,RB1, when cloned was shown to be a tumor suppressor gene, with tumor formation depending upon loss or mutation of the second allele. Furthermore, non-heritable tumors are typically mutant or lost for the same gene by two somatic events. These principles have been useful in the study of other cancers and the molecular events that are critical in their etiology.

Although RB1 has been shown to be abnormal in all heritable cases, there are some sporadically occurring tumors in which it is not abnormal. This points to an important area for further research. Is it possible that infection with a DNA virus which inactivates RB1 is involved in etiology? The fact that there is an unusually high rate of sporadic, non-heritable retinoblastoma in underdeveloped areas of the world in which infection with such viruses as human papilloma virus is common, also supports this possibility. These circumstances can be interpreted to mean that retinoblastoma might be partially preventable, a situation for which pediatricians have always hoped. Regardless of whether or not this is possible, retinoblastoma will always be a problem as its prevalence is maintained by new spontaneous genetic events, both germinal and somatic. Since this is the case for many cancers, the need for effective therapy continues to be paramount.

We also wish to emphasize the importance of studying all retinoblastoma survivors, whether they were treated with surgery, radiation or chemotherapy. The risk of second cancers in individuals with the genetic form of retinoblastoma, whether inherited or acquired, with and without the additional risk imposed by radiation has been well studied and is only one of the critical aspects of survival. Vision, psychologic adjustment to enucleation, to orbital hypoplasia secondary to radiation therapy, and general quality of life need to be studied. There is now a significantly a large cohort of survivors of both forms of retinoblastoma, genetic and non-genetic, treated with modern techniques of surgery, radiation therapy and systemic chemotherapy for meaningful data analysis. This research should now be undertaken before the opportunity is lost to alter therapy based on our knowledge of the long-term effects of the treatment which these survivors received. It is also essential to embark on this “survivorship” research agenda in order to develop standards for the follow-up care of those who are at risk for other cancers and possibly other late effects of treatment.

As we look back on the enormous progress made in understanding various aspects of the science of retinoblastoma, in its etiology and treatment successes, we hope that investigators who study other childhood cancers and cancers in young adults, will also acquire the knowledge that allows them to reap similar successes.

In the medical literature there is a lack of a comprehensive textbook that covers all aspects of retinoblastoma management. In this textbook, experts from a wide range of subspecialties have compiled their knowledge and experience to serve as a reference guide to readers. The basic idea of this book was based on the question: if I were a practicing physician in any part of the world and wanted to treat children with retinoblastoma which one book would I have for reference? Our book is designed to be the most comprehensive and authoritative text in one volume, co-authored by leading physicians and scientists worldwide. We have 70 contributors from many countries including Argentina, Belgium, England, France, India, Italy, Korea, Mexico, the Netherlands, the Philippines, Switzerland, Turkey, and the USA.

This book is divided into seven sections including epidemiology/pathogenesis, clinical features, chemotherapy, radiation therapy, advanced retinoblastoma, pathology and supportive care. In this book, we have also emphasized the quality of life in children treated for retinoblastoma by addressing not only the diagnostics and management but also visual rehabilitation, ocular prosthesis and psychosocial aspects. The book is extremely illustrative with approximately 350 photographs and we have included appendices at the end for quick reference of chemotherapy regimens and genetic counseling. Medicine is an ever changing, ever growing field and hence we have included sections with newer developments and future trends. Thanks to the multiple esteemed contributors; we hope this text will be a valuable source for physicians caring for retinoblastoma patients.

We would like to acknowledge our colleagues who have assisted in the care of these patients. From the pediatrician who first detects an eye problem in a child to the pediatric ophthalmologist who suspects the diagnosis of retinoblastoma to the ocular oncology team that manages the patient and to all of the associated teams of pediatric oncologists, radiation oncologists, interventional neuroradiologists, endovascular neurosurgeons, pathologists, and counselors who provide expertise to the patient's medical care, we thank you. A powerful team of physicians working together is the key to the patient's outcome. We are grateful to all colleagues who have provided medical care to the children with retinoblastoma.

We appreciate the efforts of the publishing company Jaypee Brothers Medical Publishers, New Delhi, India for allowing us to culminate our dream of this written textbook. Chetna Malhotra Vohra (Senior Manager–Business Development) and Payal Bharti have been particularly supportive and have provided creative ideas. We are thankful for their interest and publication assistance.

Last but not least, we credit our young patients and their families for the honor of providing their medical care. For the patient, we appreciate their trust in our decisions and skills. Together we work. We will not forget the rollercoaster of emotions experienced by these young patients including smiles and tears, cheerfulness and discomfort, and timidness and valor. For the families, retinoblastoma treatment can be fraught with fears of death, of blindness, and of the loss of one or two eyes in their precious young child. These are nearly incomprehensible fears that eventually resolve as the disease is controlled. In conclusion, to all patients and families with retinoblastoma, this book was written for you.