Controversies in the treatment of lung cancer.
Article Type: Book review
Subject: Books (Book reviews)
Author: Julka, P.K.
Pub Date: 12/01/2010
Publication: Name: Indian Journal of Medical Research Publisher: Indian Council of Medical Research Audience: Academic Format: Magazine/Journal Subject: Biological sciences; Health Copyright: COPYRIGHT 2010 Indian Council of Medical Research ISSN: 0971-5916
Issue: Date: Dec, 2010 Source Volume: 132 Source Issue: 6
Topic: NamedWork: Controversies in the Treatment of Lung Cancer (Nonfiction work)
Persons: Reviewee: Heide, J.; Schmittel, A.; Kaiser, D.; Hinkelbein, W.
Accession Number: 247634571
Full Text: Controversies in the treatment of lung cancer, J. Heide, A. Schmittel, D. Kaiser, W. Hinkelbein, editors (S. Karger, Basel, Switzerland) 2010. 214 pages. Price: US$ 188.00 ISBN 978-3-8055-9298-7

Globally, lung cancer is the second most common cancer among males and females after prostate and breast respectively; but it is the commonest cancer in both genders combined. It is also the commonest cause of death due to any cancer; and the deaths due to lung cancer outnumber the deaths due to colon, breast and prostate cancer combined.

Despite advances in diagnosis and treatment, lung cancer still remains a challenge for the treating oncologist. A large percentage of patients present with metastatic disease where cure is not an option; and the situation gets worsened by the presence of co-morbidities due to smoking, since most of these patients have a history of smoking.

This book provides a comprehensive review of the current treatment of lung cancer. It gives a good review of lung cancer management and is written in a lucid style with a holistic approach. The book is divided into six sections- diagnostic workup; NSCLC: Stage I/II disease; NSCLC: Stage III disease; NSCLC: palliative procedures in Stage IV; small cell lung cancer and a very interesting section on the use of complementary and alternative medicine in lung cancer. Most of the sections are further divided into chapters to segregate the content and enable easy understanding. Each chapter begins with a concise abstract, which gives an outline of the contents of the chapter. The chapters are richly illustrated with black and white and coloured photographs; images; graphs and line diagrams; and have numerous tables with comprehensive information.

The section on diagnostic workup has five chapters. The chapters on Prognostic Factor in Histopathology of Lung Cancer discusses the prognostic role of histologic subtypes and molecular markers such as EGFR, K-RAS, ERCC, RRM1, TS is NSCLC and gives an excellent algorithm for use of individualized chemotherapy in NSCLC using histologic subtypes and immunohistochemical markers. The chapter on FDG- PET/CT in Lung Cancer: An Update, describe the importance of PET-CT in initial diagnosis, evaluation of therapy response, detection of recurrent tumour, radiation therapy planning and the multidisciplinary management of patients with NSCLC and small cell lung cancer. The chapter on Whole-body MRI for Staging of Lung Cancer gives an overview of initial clinical results obtained with whole-body MRI in staging lung cancer. The chapter on bronchoscopy/endobronchial ultrasound gives a nice review of the current status of EBUS-TBNA technique and its applicability in lymph node staging as well as diagnosis. The final chapter in this section is on New Developments in Videomediastinoscopy--Video assisted mediastinoscopic lymphadenectomy and mediastinoscopic ultrasound.

The section on NSCLC: Stage I/II disease has four chapters. The chapter on Resection in Stage I/ II Non-Small Cell Lung Cancer discusses lobectomy including VATS lobectomy, sleeve resection and other limited resections as surgical options in patients with early stage NSCLC and gives a very pertinent conclusion that further subclassifications of stage and histopathological properties will enable us to define a better estimation of prognosis and a "tailored" individual treatment. The chapter on Role of Mediastinal Lymph Node Dissection in Non-Small Cell Lung Cancer discusses mediastinal lymph node dissection (MLND) and systematic lymph node sampling (SS); and the authors advocate for complete interlobar, hilar and mediastinal lymphadenectomy as compartment dissections in patients with NSCLC. The chapter on Radiation Therapy for Early Stage (I/II) Non-Small Cell Lung Cancer discusses the role of radiotherapy using standard or altered fractionation in these stages of lung cancer and also has a good discussion on radiotherapy related toxicities. The chapter on Stereotactic Body Radiation Therapy (SBRT) for Early Non-Small Cell Lung Cancer is an excellent review of the technique, biological basis, clinical experience and future of SBRT in early NSCLC.

The section on stage III disease has five chapters. The chapter on Extended Surgical Resection in Stage III Non-Small Cell Lung Cancer discusses surgical options in Stage III NSCLC and the authors conclude that surgery should be recommended when resection is radical including systematic lymph node dissection and mortality and morbidity are low; and that a multimodality approach is needed in most cases to achieve a successful radical therapy. The chapter on Stage III: Definitive Chemoradiotherapy reviews the optimization of combined radiotherapy and chemotherapy with a good discussion on trials using the sequential and concurrent approach, the optimal regimens to be used, and the influence of co-morbidities on outcome. The chapter on Adjuvant Therapy in Early-Stage Non-Small Cell Lung Cancer discusses the landmark studies and meta-analysis in the adjuvant setting in NSCLC; as well as very relevant section on patient selection and predictive or prognostic factors. The chapter on Postoperative Irradiation in Non-Small Cell Lung Cancer has described the evidence thus far which indicates that adjuvant irradiation should be limited to patients with Stage IIIA N2 disease or to the rare IIIB N3 disease; but there are limitations to the data such as inadequate irradiation or improper patient selection. The chapter on Altered Fractionation Schemes in Radiotherapy discusses hypofractionated stereotactic body radiotherapy for Stage 1 NSCLC and hyperfractionated accelerated radiotherapy for stage III NSCLC.

The section on palliative procedures in Stage IV contains two chapters. The chapter on Chemotherapy of Advanced Non-Small cell Lung Cancer discusses for Stage IV patients - cisplatin vs carbopalatin based chemotherapy, newer drugs like Pemetrexed, special situations such as elderly patients and patients with reduced performance status, customized chemotherapy using molecular markers, targeted therapies, the evolving concept of maintenance therapy, second line chemotherapy and assessment of efficacy. The chapter of Radiotherapy discusses the palliative potential of radiotherapjy for Stage IV NSCLC, the various treatment strategies and a very concise tabulated description of studies with palliative radiotherapy in NSCLC.

The section on small cell lung cancer has four chapters. The chapter on Treatment of Limited Disease Small Cell Lung Cancer discusses the various aspects of thoracic radiotherapy- optimal dose and fractionation, target volumes, timing, sequencing with chemotherapy and overall treatment time and patient selection. The chapter on Radiochemotherapy in Extensive Disease Small Cell Lung Cancer discusses the concept of integrating chemotherapy and radiotherapy in various schedules to improve outcomes in this group of patients. The chapter on Radiotherapy for Extensive Stage Small Cell Lung Cancer gives a very good review of studies for prophylactic cranial irradiation and thoracic radiotherapy in these patients. The chapter on controversies in the treatment of Advanced Stage of Small Cell Lung Cancer discusses the controversies in drug regimens and dosages in first-line chemotherapy, prophylactic cranial irradiation after first-line chemotherapy and second-line chemotherapy in these patients.

The final section contains an interesting chapter on Complementary and Alternative Medicine (CAM) in Lung Cancer Patients: A Neglected Phenomenon? Which describes the results of a study which looked at whether patients with lung cancer were CAM users or CAM non-users. The authors conclude that the use of CAM is frequent in lung cancer patients (54% in the study reported) and that it is important to obtain information on the CAM use of patients and particularly in controlled clinical trials, to prospectively document it.

Simple language, a concise format and focus on controversial/unresolved issues in lung cancer management are the strong points of this book.

Recommended reading for all those who have to deal with lung cancer.

P.K. Julka

Department of Radiotherapy (IRCH)

All India Institute of Medical Sciences

Ansari Nagar, New Delhi 110 029, India
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