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section is outdated today, reflecting the fact that two ASCO meetings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
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.