Advances in Radiation Oncology in Lung Cancer

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Details:

B Jeremic (ed)
Springer (2005)
ISBN: 3-540-00522-6 
512 pages plus index
RRP: $US259.00


13-50-64-7A-D7-2E-C0-77-21-14-F8-24-07-A5-3A-91This handsomely produced and beautifully illustrated book provides a comprehensive overview of recent developments in lung cancer radiation oncology. The editor, Dr Jeremic, has assembled an international pantheon of 79 experts, most of whom are well known as leaders in their fields. It is hard to think of a topic which has not been covered: there are chapters on the radiotherapy of recurrent lung cancer, intraoperative electron beam therapy and the use of heavy particles, in addition to more standard subjects such as radiochemotherapy for locally advanced non-small cell lung cancer and prophylactic cranial irradiation in small cell lung cancer. The editor may have been too inclusive with chapters on surgery, photodynamic therapy and brain toxicity, which are not germane to the book’s title. There is a chapter on contemporary issues in staging of lung cancer, which describes staging techniques, but not the TNM classification, which appears in the chapter on surgery. I would have liked to see a critique of the current TNM system as it affects the radiation oncologist’s choice of treatment.

The standard of the contributions is variable. The chapter on radiobiology of normal lung and lung tumours is brief. It has a section on testing of tumour proliferative activity, but there is no reference to accelerated repopulation. It also has a section on diagnostic value of FDG PET scanning, which seems strange in a chapter devoted to radiobiology.

While there is a lot of information in this book, there are omissions. The chapter on radiation time, dose and fractionation makes only passing reference to the CHART study, which deserves a far more detailed analysis. It is also stated in the same chapter that “whether thoracic radiation therapy should be delivered early or late…in the treatment of small cell lung cancer …remains controversial”. The authors then go on to describe a randomised trial which showed a benefit for early radiotherapy, but have not mentioned the systematic review first reported by Fried et al in 2003 which also favours early radiotherapy. In light of this level one evidence, is “early or late” still controversial?

A topic which is truly controversial, in spite of level one evidence, postoperative radiotherapy for completely resected non-small cell lung cancer, is discussed by Haynes and Machtay in detail. The mauling they give the PORT meta analysis (which showed a detriment for postoperative radiotherapy) makes for interesting reading.

There are useful, practical chapters on target volume delineation for both non-small cell lung and small cell lung cancer. It is gratifying to see the Australian target volume delineation protocol, which was developed for use in one of the current Trans Tasman Radiation Oncology Group’s studies, being reproduced in full in a chapter on treatment planning by Martel.

With so much information, the practising radiation oncologist is sometimes left wondering how to treat the patient with stage IIIA non-small cell lung cancer who next walks in the door. Should it be CHART? Or chemoradiation? Should the patient have neoadjuvant therapy followed by surgery? Unfortunately books like this do not give the answers and the practitioner has to look to practice guidelines for that kind of information. Nevertheless, I learned a lot from reading this book and can recommend it as a useful reference for those interested in the rapidly evolving radiotherapeutic management of lung cancer. One final quibble: the index, occupying only three pages for a book of this size, is totally inadequate.

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