B Movsas et al (eds)
Published by Marcel Dekker (2001)
ISBN: 0-8247-0274-3. 520 pages plus index.
In my experience, the aspect of their knowledge base which troubles our trainees most as they approach their final exam is the difficulty they have in resolving controversy in such a way as to please the examiners. Our registrars need to be reminded that there are many disagreements even among experts on how to best manage particular oncological problems, usually related to an absence of high level evidence, and that the examiners are (or should be) just as aware of those unresolved issues as are the bewildered candidates.
This book, edited by a multidisciplinary trio of surgeon, medical oncologist and radiation oncologist, has brought together a large number of experts in the field to address the major controversies in lung cancer (both small cell and non-small cell). Sometimes this is done in a debate format, with one team taking the affirmative, and the other the contrary position on topics such as the timing of chest irradiation in small cell lung cancer, the role of extended resections in patients with stage IIIB non-small cell lung cancer, and the value of 3D conformal radiotherapy. That respected authorities can take opposite points of view on these clinically important subjects should reassure our registrars that they are not the only ones who are confused! Sometimes the contrary argument is unsustainable, as for example Dr Sandler arguing against prophylactic cranial irradiation (PCI) in small cell lung cancer. His grudging concession that “PCI should be offered at this time as part of the therapeutic regimen in patients with limited small cell lung cancer” appears among such statements as: “The potential benefit from PCI is so small (~5%) that a meta-analysis became necessary to identify any impact at all,” and: “Although meta-analyses have achieved recent popularity, not all statisticians are convinced of their accuracy.”
The debate format, which requires participants on occasion to make statements that differ from their privately held views, does enliven discussion and makes for much more enjoyable reading than a ponderous catalogue of published studies spared critical appraisal which seems to be commonplace in recent oncology textbooks.
Unfortunately, not all the contributions are in debate format, and not all deal with controversy. For example, the chapter entitled “Evolving role of chemotherapy in stage IV non-small cell lung cancer” does not address any particular controversy, but does make a brief reference to tirapazamine, which in its unqualified form is not particularly helpful to the reader. I think these more traditional chapters could have been omitted bringing the areas of genuine controversy into sharper focus.
So, like the curate’s egg, this book is good in parts. I do not know where our registrars are likely to find a more interesting account of the major controversies in lung cancer management as they stand in 2002. Next time one of them asks you if patients with N2 non-small cell lung cancer should be treated with chemoradiation, or with induction chemotherapy followed by surgery, don’t inflict on them your personal prejudice, but instead point them in the direction of this book, where they can read both sides of the argument.