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Clinical Radiation Oncology

Clinical Radiation Oncology

Clinical Radiation Oncology, edited by Drs. Gunderson and Tepper, is a first-edition textbook designed primarily for those in the field of radiation oncology. However, the book attempts to present a multidisciplinary approach to cancer treatment and may be of interest to surgical and medical oncologists as well.

The editors realized that no single editor or group of editors has sufficient expertise in all subjects to write a comprehensive textbook. Thus, eight associate editors were selected to assist in the compilation of this text, which features the contributions of 142 authors. Many of the authors are recognized experts in their field. The material presented is up-to-date and extensively referenced.

The book is divided into three logically organized sections. The first section, "Scientific Foundations of Radiation Oncology," covers the basic principles of radiation oncology, surgical oncology, and chemotherapy. Included are chapters on the interactions of chemotherapy and radiation along with basic statistics and clinical trials. The chapters on the principles of surgical oncology and chemotherapy are short and designed to provide the reader with the basics necessary for a rudimentary understanding of these specialties.

The second section, entitled "Techniques and Modalities," contains eight chapters that focus on the principles of radiation techniques. Within the section are chapters on (1) brachytherapy, (2) intraoperative irradiation, (3) stereotactic irradiation, (4) particle radiation therapy, (5) three-dimensional (3D) conformal radiation, (6) hyperthermia, (7) radioimmunotherapy, and (8) palliation of metastases. The chapters begin with a discussion of the technical background of each modality and end with examples of clinical applications. Except for hyperthermia and 3D conformal radiation therapy, the technical descriptions in most chapters lack depth. A major portion of each chapter is devoted to the clinical applications of each technique and focuses on its usefulness in specific disease sites.

Additional technical information is presented as it applies to the specific disease site, along with the results of treatment. These chapters emphasize the disease- and site-specific results of treatment, and although the clinical examples are useful, it would have been more helpful if such information on clinical outcome had been presented instead in the third section, on disease sites.

I was surprised that a new textbook on radiation oncology did not devote a chapter to intensity-modulated radiation therapy. This is the latest advance in the delivery of radiation treatment and a major area of investigation in oncology. It is mentioned in passing in the chapters on stereotactic radiosurgery and 3D conformal radiation. However, a full formal presentation of this technique and its vast potential is lacking.

The third and largest section of the book is entitled "Disease Sites." In this section, there are 10 major subdivisions devoted to the major disease sites. Each subdivision contains individual chapters on specific disease sites. For example, the subdivision on "Thoracic Tumors" contains chapters devoted to small-cell lung cancer, non-small-cell lung cancer, and esophageal cancer.

The editors have attempted to maintain a consistent format throughout the disease site section. Each subdivision begins with an overview of the disease. Many of the overviews are concise summaries of the group of related diseases explored in the chapters that follow. The better overviews discuss general epidemiology, biology, and treatment considerations, and highlight some of the controversial aspects of the diseases in question. However, some of the authors choose to discuss a few unusual disease sites instead of providing a big picture. For example, the author of the overview on genitourinary tumors refers the reader to the individual chapters on each disease and, rather than providing a brief summary, discusses the esoteric topic of penile cancer.

The individual chapters are well thought out and presented in a consistent format to enhance their usefulness. The opening page of each chapter begins with a capsule summary of the disease in question. This summary highlights the incidence, staging, and typical treatment options in a short, easy-to-read tabular format. Most chapters contain discussions of etiology, prevention, detection, patterns of spread, therapeutic options, results, and toxicity. Many also contain useful information on treatment planning. Treatment outcome data are presented for each site, in most cases including local control, distant control, and survival rates.

The text is unique in its presentation of treatment algorithms at the end of most of the site-specific chapters. This provides the reader with a quick method of determining the optimal treatment for an individual patient. Unfortunately, not all chapters have algorithms, and some algorithms are more useful than others.

In summary, the text is well edited, and the consistent format makes the volume easy to use. The information presented is well researched and up-to-date. The discussions of radiation therapy techniques as they pertain to each disease site and frequent use of illustrations are particularly good. Standard treatments are presented clearly, and controversial areas are highlighted.

The shortcomings of the text include the lack of a section on intensity-modulated radiation therapy and the lack of depth in some chapters. Also, the book could benefit from a few organizational changes. For example, the color plate illustrations are grouped and appear far from their citations in text. Nevertheless, the text is a good overview of current issues in radiation oncology.

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