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Progress in Respiratory Research Series. Volume 29. Updates in Advances in Lung Cancer. J H Schiller. (Pp 192; $160.00). Switzerland: Karger, 1997. 3 8055 6557 7.
Reasonably digestible reviews of recent clinical trials in the management of lung cancer are rare and, in general terms, this 11 chapter book is welcome. The emphasis here is on the use of chemotherapy and radiotherapy in the management of lung cancer, with eight of the 11 chapters considering these aspects, and the other three are concerned with chemoprevention, palliative medicine, and molecular biology.
Nine of the 11 authors are from the USA. The chapters take the form of a traditional review and are reasonably well set out with an average of about 50 references for each topic. The strengths of the book are the comprehensive assessment of novel drug therapies, with separate chapters for paclitaxel/carboplatin, gemcitabine, and docetaxel in non-small cell lung cancer, and a separate chapter on novel drugs for small cell lung cancer, including the topoisomerase-1 inhibitors, carboplatin, and the taxanes.
Sadly, the volume lacks an adequate introduction by the Editor, which would have been useful if it had been able to point out the “major messages” from each of the chapters—for example, bringing out the importance of the recent meta-analysis of trials of prophylactic cranial irradiation in responding small cell lung cancer, or the superiority of standard intravenous regimens over low dose oral etoposide in this disease. Surgery gets no mention at all, and nor does endobronchial therapy. This is a pity since there have been major advances in our understanding of the role of endobronchial treatments, and the literature, particularly that relating to brachytherapy, is badly in need of review. Likewise, I found the chapter on palliative medicine disappointing with no consideration of psychosocial problems or some important major physical symptoms such as cough and pleural disease, and a misplaced discussion here of the meta-analysis of chemotherapy in non-small cell lung cancer. The best chapter, in my view, was that by Wagner on radiation therapy in small cell lung cancer which was a well set out discussion of the attempts that have been made to optimise local control by altering the timing and fractionation of thoracic radiotherapy, together with an up to date discussion on prophylactic cranial irradiation. The book is just about up to date enough to include the results of the important MRC study on continuous hyperfractionated accelerated radiotherapy for non-small cell disease (CHART), which must now be considered as one of the few studies on radiotherapy recently to have shown an improvement in survival compared with local control.
This book will not appeal to the non-specialist, though it would be a useful starting point for doctors or groups who want an up to date background account as a preliminary to designing their own studies or choosing a pattern of management for their patients. Inevitably, in a fast moving field such as the assessment of novel drug therapies for lung cancer, a book like this will rapidly become out of date and, as with guidelines, I would estimate that “an update of this update” will probably be needed within a couple of years.—MFM
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