Regional Chemotherapy Theory and Practice
D J Kerr and C S McArdle (Eds)
Published by Harwood (2000)
ISBN: 90-5702-436-5. 100 pages plus index.
Demonstrating the clinical benefits of regional chemotherapy remains the holy grail for some clinical researchers. A major problem is the use of data from uncontrolled clinical trials as evidence of benefit.
This short book of only 100 pages tries to supply a conceptual and scientific basis for “a revolution in the use of cytotoxic drugs”. The preface calls it a textbook but the contents are too controversial and imprecise to justify that label.
The first chapter is a rather dense and mathematical discussion of the pharmacokinetics of regional therapy. The next chapter looks at the use of intraperitoneal chemotherapy. Although not specifically stated, the clinical data is restricted to ovarian cancer. There is a comprehensive overview of the pros and cons of this specific approach.
The discussion on the use of regional chemotherapy for colorectal liver metastases mainly represents the experience of the group in Edinburgh. It lacks information about a number of more recent studies. The fourth chapter is on melanoma. It appears to have been written some time ago. For example it ignores the final report on the international multi-centre randomised study of adjuvant perfusion published in the Journal of Clinical Oncology in September 1998.
The chapter on breast cancer seems to ignore the generally accepted belief that micrometastases are present in many patients at the time of presentation and therefore systemic therapy is appropriate, even for preoperative treatment. The next chapter returns to the subject of colorectal cancer, this time examining portal vein perfusion. Why it does not follow chapter three is a mystery. It contains a good description of the basis of this technique. However the clinical data are very brief and uncritical.
The presence of a chapter on cryotherapy in this book appears to be a mystery until one comes across a statement that all patients have an hepatic artery catheter placed for regional chemotherapy. Unfortunately no further details are provided. However the lack of any control data at all makes this just one more complicating factor in assessing the benefits of cryotherapy.
The final chapter is on regional chemotherapy as applied to the CNS and the intrapleural space. The paragraph on the diagnosis of leptomeningeal disease ignores the use of MRI as a diagnostic modality. The subsequent section on intra-carotid infusions could have been usefully expanded as this is an area that is relatively unknown, although the therapeutic potential is very limited. The sections on intrapleural therapy focus mainly on chemical pleurodesis for effusion.
In summary, this book is of little interest except as a guide to someone inclined to write a more definitive text on this subject.