British Journal of Radiology (2004) 77, 1065
© 2004 British Institute of Radiology
doi:
Radiation oncology for cure and palliation. Edited by RG Parker, NA Janjan and MT Selch, pp 280, 2003 (Springer-Verlag, Berlin, Heidelberg), £104.00 ISBN 3-540-41401-0
B Jones
The Springer-Verlag series of well produced, highly specialized and expensive Radiation Oncology books are usually invaluable to any serious oncology library. This book is a little different from the others in that it is so general and veers away from the technical aspects of radiotherapy. The three authors are from the USA and consequently the book reflects their best practice. There are many philosophical connections with the Old Country, with quotes from some English physicians, e.g. John Keats ("Pleasure is oft a visitant, but pain clings cruelly to us") and William Osler's advice that "it is more important to know what kind of patient has the disease than what kind of disease the patient has", which is used rather provokingly at the beginning of a chapter on intracranial metastases. Fortunately, the advice of more modern English physicians are also included, particularly the work of Price, Gaze, Hoskins et al in the management of bone metastases, although the Royal College which sponsored such pioneering work is not mentioned, another reminder that the War of Independence continues to cast some shadows.
The book begins with general approaches to the management of pain (with an economic appraisal), then considers metastasis to bone and the various treatment approaches with an emphasis on radiotherapy and again ends with a discussion on costs. Subsequent chapters include spinal cord compression and superior vena cava obstruction. Then the gastrointestinal s\ystem is covered by means of individual small chapters (reminiscent of Caesar's Commentari de Bello Civili) on each site such as pancreas, gall bladder, hepatic metastases, stomach etc. In contrast, the lung is covered in two chapters, the second being pleural mesothelioma. The breast is dealt with in one longer chapter of only 11 pages, nearly three of which are references. Primary CNS tumours, soft tissues sarcomas and cancers of the Head and Neck, gynaecological and urological systems are also covered in reasonable detail within a relatively short space.
If the serving of delicious lobster bisque indicates a good restaurant, then oncology books can arguably be judged by how well the difficult topic of malignant melanoma is covered. There is no chapter devoted to malignancies of the skin and their locoregional and metastatic complications and melanoma is mentioned only once in the context of nasal fossa tumours. Another deficit is that metastasis to the eye is not considered as a special topic, although it merits a very short section in the breast cancer chapter. Throughout the book the emphasis is on the cessation of pain, which is amenable to measurement, but relatively little attention is given to recurrent bleeding and superficial infection, which can be such a horrid problem in many cancer patients. The scope for re-irradiation could be given more prominence.
The book ends with a chapter devoted to "End-of-Life Care", which conveniently disposes of the misleading adjective "terminal" and begins with a quote from the largely self-taught and streetwise author Jack London: "the proper function of man is to live, not to exist. I shall not waste my days in trying to prolong them". A longer discussion on ethical issues is probably necessary, although there is a short, sensible and useful section on the "legal barriers to end-of-life care" including patient or surrogate consent; the very final section is again on costs.
There is an appendix of lists, by anatomical site, of useful drugs used in the palliation of cancer symptoms. The references are fairly exhaustive and will be useful for academic studies; the content seems well up to date (e.g. protons are mentioned). This book will be helpful to those early in their training and for those interested in whether to pursue a career in oncology. There are hardly any diagrams or technical displays, so that the book can be read by those who have not yet passed the part I examination of the Royal College of Radiologists. For part 2 examination candidates, some of the small chapters dedicated to rare cancer sites would be useful although the lack of technical information would need to be supplemented from other sources. It could usefully be read by nurses, medical oncologists, hospital managers, members of Strategic Health Authorities and Primary Care Trusts or enquiring non-executive members of NHS Trust Boards. Experienced Consultants should also enjoy reading many parts, for its wisdom and practical advice backed up by a considerable evidence base.
