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Book Review: Adjuvant Therapy of Cancer--VII

Book Review: Adjuvant Therapy of Cancer--VII

This is the seventh in a well-known series of conference summaries, organized and edited by Dr. Salmon. A perusal of the contents of these volumes over the past two decades reveals the evolution of concepts related to combined-modality therapy in cancer. Although the word "adjuvant" remains in the title, many of the trials reviewed in the current volume involve "neoadjuvant" approaches, in which chemotherapy precedes rather than follows local treatment, or the use of combined modalities without surgery.

The first portion of the volume (65 of the total 464 pages) is devoted to "scientific overview and perspectives," including a discussion of tumor angiogenesis by Folkman and a review of the effects of adjuvant tamoxifen on insulin-like growth factor (IGF-I), which could explain the modest benefits observed in some trials of this drug in hormone receptor-negative patients.

In head and neck cancer, two provocative but inconclusive trails of simultaneous chemoradiation are presented, as well as an illuminating paper by Ensley on the inadvertent impact of selection criteria on trials of adjuvant therapy in head and neck cancer. (A requirement for "negative margins" leads to inclusion of more diploid tumors, which are less chemotherapy-responsive.) The lung cancer section is outdated today, reflecting the fact that two ASCO meetings have taken place since this conference. Based on randomized trials of which the outcome was not known in March 1933, there is now strong evidence for chemotherapy and irradiation vs irradiation alone in inoperable stage III disease, and some evidence of benefit from neoadjuvant chemotherapy in patients with stage III resectable disease.

The breast cancer section again forms the core of this volume, with overviews of the experiences of the experiences of Bonadonna, the National Surgical Adjuvant Project for Breast and Bowel Cancers, and the Ludwig group, as well as the phase II trials of MD Anderson Cancer Center. Of particular interest is the 10-year update of a large French study, showing a clear advantage for doxorubicin-based therapy over CMF in premenopausal women with positive nodes. Follow-up of mature Italian and German randomized studies addressing chemohormonal therapy and treatment duration is also presented.

The sections od gastric, colorectal, and genitourinary cancers and sarcoma/melanoma are devoted primarily to results of phase II trials. Of the two overviews provided, that by Alberts on ovarian cancer suffers from omission of the outcome of adding paclitaxel (Taxol) to platinum-based therapy, and the meta-analysis of sarcoma trials reaches a positive conclusion that may not be generally applicable (eg, many of the trials excluded trunk/abdomen primaries).

Through no fault of the editor or meeting organizers, parts of this book have already become dated. Still, it affords a useful snapshot in time of the state of a dynamic art, and the volume is worth having for the comprehensive overviews and mature data summaries on breast cancer alone.

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