Clinical Radiation Oncology

Clinical Radiation Oncology, edited by Drs. Gunderson andTepper, is a first-edition textbook designed primarily for those in the field ofradiation oncology. However, the book attempts to present a multidisciplinaryapproach to cancer treatment and may be of interest to surgical and medicaloncologists as well.

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

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

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

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

I was surprised that a new textbook on radiation oncology didnot devote a chapter to intensity-modulated radiation therapy. This is thelatest advance in the delivery of radiation treatment and a major area ofinvestigation in oncology. It is mentioned in passing in the chapters onstereotactic radiosurgery and 3D conformal radiation. However, a full formalpresentation 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 subdivisionsdevoted to the major disease sites. Each subdivision contains individualchapters 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 formatthroughout the disease site section. Each subdivision begins with an overview ofthe disease. Many of the overviews are concise summaries of the group of relateddiseases explored in the chapters that follow. The better overviews discussgeneral epidemiology, biology, and treatment considerations, and highlight someof the controversial aspects of the diseases in question. However, some of theauthors choose to discuss a few unusual disease sites instead of providing a bigpicture. For example, the author of the overview on genitourinary tumors refersthe reader to the individual chapters on each disease and, rather than providinga brief summary, discusses the esoteric topic of penile cancer.

The individual chapters are well thought out and presented in aconsistent format to enhance their usefulness. The opening page of each chapterbegins with a capsule summary of the disease in question. This summaryhighlights 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, andtoxicity. Many also contain useful information on treatment planning. Treatmentoutcome 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 algorithmsat the end of most of the site-specific chapters. This provides the reader witha quick method of determining the optimal treatment for an individual patient.Unfortunately, not all chapters have algorithms, and some algorithms are moreuseful than others.

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

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