- Email: [email protected]
Ready resource for radiotherapists
Media Watch
Books Cancer past, present, and future In this detailed monograph, Guy Faguet, professor emeritus at the Medical College of Georgia (Augusta, GA, USA) adds his voice to the growing commentary on the status of the so-called war on cancer. By combining history, statistical analysis, medical literature, and his professional experience in the cancer clinic and laboratory, the author analyses the obstacles that have hindered the development of effective cancer therapies. Notably, Faguet not only provides an analysis of past practices and policies; he also surveys current work and recommends directions for future improvements in cancer control in the USA. Faguet begins The War on Cancer by arguing that the federally funded health effort, first launched in 1971, was a misguided campaign that quickly stagnated. Faguet implicates clinicians, clinical researchers, their sponsors, publishers, and members of the mass media in this problem. Members of this group, he claims, promoted the cell-kill paradigm, a model that defined cancer as a new growth that needed to be eradicated at all cost. The core of the book is devoted to the biological mechanisms of cell growth and metabolism, the identification and testing of chemotherapy drugs, and the central role of the National Cancer Institute (Bethesda, MA, USA) in governing cancer research. Faguet concludes by outlining a new view of cancer as a genetic cellular dysfunction and posits that cancer control can be achieved through a three-armed programme of prevention, early detection, and genetic and molecular targeting.
The author should be commended for the broad scope of this book. He masterfully explains advanced biomedical concepts, but also provides ample guideposts for the more advanced reader to skip these explanations and seamlessly follow his overarching narrative. A review of the footnotes shows that he has thorough command of recently published research, his primary source of evidence. The book should be of interest to clinical oncologists, or others interested in an informed critique of cancer research and treatment written by a peer. Unfortunately, Faguet neglects to cite the many authors who have publicly critiqued—and defended—the war on cancer since its 30th anniversary, so evaluation of his opinions against other recent claims is difficult. In fact, a paucity of secondary sources is a weakness throughout the book. For example, Faguet includes sections on medical history in several chapters, but neglects a growing body of historical and sociological literature on closely related topics, such as early detection efforts, debates over breast-cancer treatment modalities, and the development of clinical trials. Readers are advised to consider The War on Cancer alongside several other recent books and articles to gain a comprehensive understanding of past events, current debates, and future goals.
The war on cancer: an anatomy of failure, a blueprint for the future Guy B Faguet Springer, 2005 £32·00 (US$59·95, €47·55), pp 227 ISBN 1 4020 3618 3
Gretchen Krueger [email protected]
Ready resource for radiotherapists This book cannot serve as a standalone reference for clinical oncologists, but a niche should exist on most bookshelves for a volume such as this. The text “aims to provide a practical guide to the use of external-beam radiotherapy highlighting the technological advances that have been made in recent years, giving a firm background to the physics of external-beam radiotherapy and then dealing with each anatomical site in turn with details of the indications and techniques used for treatment delivery”. The underlying pillar of radiobiology is not formally discussed, and stereotactic radiosurgery of tumours affecting the brain and in extracranial locations is also not addressed in any detail, despite the increasing volume of published research and substantial recent interest in hypofractionated image-guided treatment. The introduction is followed by a chapter each on basic physics and on conformal and intensity-modulated treatment; the book closes with chapters on paediatric http://oncology.thelancet.com Vol 8 January 2007
radiotherapy, palliative radiotherapy, and quality assurance in radiotherapy. In between are eleven site-based chapters that span all commonly treated sites. Because the chosen focus is on the role of external-beam radiotherapy, the appropriate integration of surgery, systemic treatment, and brachytherapy in the treatment of cancer is not always emphasised. (A companion volume has already been published on brachytherapy, and another is planned on radioisotope therapy.) The recommendations in many of the chapters are adequately supported by class I data from randomised controlled clinical trials. For many chapters, a dearth of class I data precludes the inclusion of evidence-based guidance for all clinical scenarios, and the recommendations made often represent the local practice patterns of the contributing authors. Many of the tumour sites for which less class I data exist are those for less common malignancies; those tumours
Radiotherapy in practice: external-beam therapy Peter Hoskin (Ed) Oxford University Press, 2006 £45·00 (US$87·65, €66·63), pp 465 ISBN 0 19 852929 5
17
Media Watch
for which clinical trials have not yet addressed valid questions, and those sites in which meta-analyses have not cut through a Gordian knot of uncertainty. Although this volume can give some quick guidelines for such tumour sites, the more detailed reviews in more comprehensive textbooks or specific online searches done on PubMed or cancer databases might provide more appropriate recommendations about how to combine systemic treatment with radiation, and how to best sequence treatments such as surgery and irradiation. Inconsistencies in treatment recommendations are occasionally glaring: eg, for preoperative treatment of oesophageal cancers extending into the proximal stomach, the recommendation is made to not add a margin more than 2 cm beyond the macroscopic tumour because of the “poor tolerance of gastric mucosa”. Two pages later, for gastric cancer treated radically, a recommendation is made that the entire stomach be treated with 45–50 Gy, with a possible smaller volume taken 10% higher in dose. The apparent paucity of familiarity with results of stereotactic
radiosurgical treatment for meningioma leads to the design of a very odd target volume in the chapter on tumours of the central nervous system; treatment of the lesion and the immediately contiguous nodular dural enhancement would markedly decrease the volume of the brain treated with high doses, and concomitantly limit treatment-related morbidity. For some oncologists, the recommended use of palliative treatments such as 21 Gy in three fractions, or 8–10 Gy as a single treatment might be startling. Recommendations such as these should reassure doubtful doctors that such rapid treatment is acceptable care in patients at the end of life. This book will probably be useful for many doctors as a quick reference for tumour sites that are less frequently encountered. Although, over-reliance on the guidelines from this text will not always lead to the best course of treatment for any given patient.
Jonathan Knisely [email protected]
Living with thyroid cancer
Get a life Nadine Gordimer Bloomsbury Publishing, 2005 £7·99 (US$15·20, €11·90), pp 208 ISBN 0 7475 8175 4
18
“Dying well is not difficult”, affirms the condemned priest in Roberto Rossellini’s Rome, Open City (1945), ”living well is the difficult part”. Get a Life’s Paul Bannerman is not actually dying, at least no more than he ever was. But, waylaid by thyroid cancer, he has caught a glimpse of the writing on the wall. The latest offering from Nobel prize laureate Nadine Gordimer—now in her 84th year—Get a Life is a likeable exploration of mortality. A family man who has devoted himself to ecology (saving the planet one might say, just as one could call mowing the lawn trimming the planet), Paul is taken aback by the jarring diagnosis; 35 seems an entirely unsuitable age to develop cancer. After performing a thyroidectomy, Paul’s doctors prescribe for him a course of radioactive iodine. As a result the patient is rendered “literally radiant. He radiates unseen danger to others from a destructive substance that has been directed to counter what was destroying him”. Paul is released to the care of his parents, to be kept in total isolation until he is no longer radioactive. As a premise this is a little far-fetched. Even assuming that radioactive iodine treatment has the subject emitting hazardous rays for weeks on end—which it doesn’t—are we to take it that South African hospitals happily discharge these glowing cancer units? (And another thing, why did Paul’s wife Benni deliver the news of his condition? Get a Life’s unseen oncologist—Jonathon—should really try to stop telephoning people and asking them to tell their husband he has cancer.) Still, comic-book powers notwithstanding, our protagonist is deposited in his family home, replete with
childhood memories—an uncomplicated exemplification of the cycle of life. Here, prompted by his intimation of the infinite, Paul begins the inevitable process of reassessment. And whereas Paul is confronting his present, his mother Lyndsay attempts to make sense of her past; a 4-year affair, concluded 15 years ago, its consequences continue to reverberate through her marriage. This is a novel about compromise. People are defined by their decisions, whether they choose to act or not to act. So as to support Lyndsay in her chosen career, the gentlemanly Adrian, Paul’s cuckolded father, declined to pursue archaeology, opting instead for a tedious but secure position in business. Now retired, Adrian questions whether sacrificing his dream was worthwhile, half a lifetime of stultifying boredom to substantiate another’s pursuit of glory. A trip to Mexico provides him with a final chance to redefine his existence, and he quietly accepts. Confined to Adrian’s study, eating from paper plates, and excluded from all physical contact, Paul wonders how to reconcile his environmentalism with a wife who works in advertising, the only industry where pollution is not a by-product, it is the product. Is it an hypocrisy for him to set up home with a woman charged with propagandising big businesses’ profiteering, glossy campaigns as sparkly tassels tied to the tail of a dragon? Of course, any novel set in South Africa has to address the issue of race. Long-standing opponent of apartheid, that systematic renunciation of all things artistic, Nadine Gordimer now finds cause for hope. She is encouraged by the emergence of trendy urban areas where different http://oncology.thelancet.com Vol 8 January 2007
Books Cancer past, present, and future In this detailed monograph, Guy Faguet, professor emeritus at the Medical College of Georgia (Augusta, GA, USA) adds his voice to the growing commentary on the status of the so-called war on cancer. By combining history, statistical analysis, medical literature, and his professional experience in the cancer clinic and laboratory, the author analyses the obstacles that have hindered the development of effective cancer therapies. Notably, Faguet not only provides an analysis of past practices and policies; he also surveys current work and recommends directions for future improvements in cancer control in the USA. Faguet begins The War on Cancer by arguing that the federally funded health effort, first launched in 1971, was a misguided campaign that quickly stagnated. Faguet implicates clinicians, clinical researchers, their sponsors, publishers, and members of the mass media in this problem. Members of this group, he claims, promoted the cell-kill paradigm, a model that defined cancer as a new growth that needed to be eradicated at all cost. The core of the book is devoted to the biological mechanisms of cell growth and metabolism, the identification and testing of chemotherapy drugs, and the central role of the National Cancer Institute (Bethesda, MA, USA) in governing cancer research. Faguet concludes by outlining a new view of cancer as a genetic cellular dysfunction and posits that cancer control can be achieved through a three-armed programme of prevention, early detection, and genetic and molecular targeting.
The author should be commended for the broad scope of this book. He masterfully explains advanced biomedical concepts, but also provides ample guideposts for the more advanced reader to skip these explanations and seamlessly follow his overarching narrative. A review of the footnotes shows that he has thorough command of recently published research, his primary source of evidence. The book should be of interest to clinical oncologists, or others interested in an informed critique of cancer research and treatment written by a peer. Unfortunately, Faguet neglects to cite the many authors who have publicly critiqued—and defended—the war on cancer since its 30th anniversary, so evaluation of his opinions against other recent claims is difficult. In fact, a paucity of secondary sources is a weakness throughout the book. For example, Faguet includes sections on medical history in several chapters, but neglects a growing body of historical and sociological literature on closely related topics, such as early detection efforts, debates over breast-cancer treatment modalities, and the development of clinical trials. Readers are advised to consider The War on Cancer alongside several other recent books and articles to gain a comprehensive understanding of past events, current debates, and future goals.
The war on cancer: an anatomy of failure, a blueprint for the future Guy B Faguet Springer, 2005 £32·00 (US$59·95, €47·55), pp 227 ISBN 1 4020 3618 3
Gretchen Krueger [email protected]
Ready resource for radiotherapists This book cannot serve as a standalone reference for clinical oncologists, but a niche should exist on most bookshelves for a volume such as this. The text “aims to provide a practical guide to the use of external-beam radiotherapy highlighting the technological advances that have been made in recent years, giving a firm background to the physics of external-beam radiotherapy and then dealing with each anatomical site in turn with details of the indications and techniques used for treatment delivery”. The underlying pillar of radiobiology is not formally discussed, and stereotactic radiosurgery of tumours affecting the brain and in extracranial locations is also not addressed in any detail, despite the increasing volume of published research and substantial recent interest in hypofractionated image-guided treatment. The introduction is followed by a chapter each on basic physics and on conformal and intensity-modulated treatment; the book closes with chapters on paediatric http://oncology.thelancet.com Vol 8 January 2007
radiotherapy, palliative radiotherapy, and quality assurance in radiotherapy. In between are eleven site-based chapters that span all commonly treated sites. Because the chosen focus is on the role of external-beam radiotherapy, the appropriate integration of surgery, systemic treatment, and brachytherapy in the treatment of cancer is not always emphasised. (A companion volume has already been published on brachytherapy, and another is planned on radioisotope therapy.) The recommendations in many of the chapters are adequately supported by class I data from randomised controlled clinical trials. For many chapters, a dearth of class I data precludes the inclusion of evidence-based guidance for all clinical scenarios, and the recommendations made often represent the local practice patterns of the contributing authors. Many of the tumour sites for which less class I data exist are those for less common malignancies; those tumours
Radiotherapy in practice: external-beam therapy Peter Hoskin (Ed) Oxford University Press, 2006 £45·00 (US$87·65, €66·63), pp 465 ISBN 0 19 852929 5
17
Media Watch
for which clinical trials have not yet addressed valid questions, and those sites in which meta-analyses have not cut through a Gordian knot of uncertainty. Although this volume can give some quick guidelines for such tumour sites, the more detailed reviews in more comprehensive textbooks or specific online searches done on PubMed or cancer databases might provide more appropriate recommendations about how to combine systemic treatment with radiation, and how to best sequence treatments such as surgery and irradiation. Inconsistencies in treatment recommendations are occasionally glaring: eg, for preoperative treatment of oesophageal cancers extending into the proximal stomach, the recommendation is made to not add a margin more than 2 cm beyond the macroscopic tumour because of the “poor tolerance of gastric mucosa”. Two pages later, for gastric cancer treated radically, a recommendation is made that the entire stomach be treated with 45–50 Gy, with a possible smaller volume taken 10% higher in dose. The apparent paucity of familiarity with results of stereotactic
radiosurgical treatment for meningioma leads to the design of a very odd target volume in the chapter on tumours of the central nervous system; treatment of the lesion and the immediately contiguous nodular dural enhancement would markedly decrease the volume of the brain treated with high doses, and concomitantly limit treatment-related morbidity. For some oncologists, the recommended use of palliative treatments such as 21 Gy in three fractions, or 8–10 Gy as a single treatment might be startling. Recommendations such as these should reassure doubtful doctors that such rapid treatment is acceptable care in patients at the end of life. This book will probably be useful for many doctors as a quick reference for tumour sites that are less frequently encountered. Although, over-reliance on the guidelines from this text will not always lead to the best course of treatment for any given patient.
Jonathan Knisely [email protected]
Living with thyroid cancer
Get a life Nadine Gordimer Bloomsbury Publishing, 2005 £7·99 (US$15·20, €11·90), pp 208 ISBN 0 7475 8175 4
18
“Dying well is not difficult”, affirms the condemned priest in Roberto Rossellini’s Rome, Open City (1945), ”living well is the difficult part”. Get a Life’s Paul Bannerman is not actually dying, at least no more than he ever was. But, waylaid by thyroid cancer, he has caught a glimpse of the writing on the wall. The latest offering from Nobel prize laureate Nadine Gordimer—now in her 84th year—Get a Life is a likeable exploration of mortality. A family man who has devoted himself to ecology (saving the planet one might say, just as one could call mowing the lawn trimming the planet), Paul is taken aback by the jarring diagnosis; 35 seems an entirely unsuitable age to develop cancer. After performing a thyroidectomy, Paul’s doctors prescribe for him a course of radioactive iodine. As a result the patient is rendered “literally radiant. He radiates unseen danger to others from a destructive substance that has been directed to counter what was destroying him”. Paul is released to the care of his parents, to be kept in total isolation until he is no longer radioactive. As a premise this is a little far-fetched. Even assuming that radioactive iodine treatment has the subject emitting hazardous rays for weeks on end—which it doesn’t—are we to take it that South African hospitals happily discharge these glowing cancer units? (And another thing, why did Paul’s wife Benni deliver the news of his condition? Get a Life’s unseen oncologist—Jonathon—should really try to stop telephoning people and asking them to tell their husband he has cancer.) Still, comic-book powers notwithstanding, our protagonist is deposited in his family home, replete with
childhood memories—an uncomplicated exemplification of the cycle of life. Here, prompted by his intimation of the infinite, Paul begins the inevitable process of reassessment. And whereas Paul is confronting his present, his mother Lyndsay attempts to make sense of her past; a 4-year affair, concluded 15 years ago, its consequences continue to reverberate through her marriage. This is a novel about compromise. People are defined by their decisions, whether they choose to act or not to act. So as to support Lyndsay in her chosen career, the gentlemanly Adrian, Paul’s cuckolded father, declined to pursue archaeology, opting instead for a tedious but secure position in business. Now retired, Adrian questions whether sacrificing his dream was worthwhile, half a lifetime of stultifying boredom to substantiate another’s pursuit of glory. A trip to Mexico provides him with a final chance to redefine his existence, and he quietly accepts. Confined to Adrian’s study, eating from paper plates, and excluded from all physical contact, Paul wonders how to reconcile his environmentalism with a wife who works in advertising, the only industry where pollution is not a by-product, it is the product. Is it an hypocrisy for him to set up home with a woman charged with propagandising big businesses’ profiteering, glossy campaigns as sparkly tassels tied to the tail of a dragon? Of course, any novel set in South Africa has to address the issue of race. Long-standing opponent of apartheid, that systematic renunciation of all things artistic, Nadine Gordimer now finds cause for hope. She is encouraged by the emergence of trendy urban areas where different http://oncology.thelancet.com Vol 8 January 2007