© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 22, 1852,
November 15, 2000
© 2000 Oxford University Press
BOOK REVIEWS |
Regional Chemotherapy: Clinical Research and Practice
M. Markman, ed. Totowa (NJ): Humana Press, 1999. 376 pp., illus. $135. ISBN 0-89603-729-0
Correspondence to: William Ensminger, M.D., University of Michigan Medical School, UpJohn Center for Clinical Pharmacology, 1310 E. Catherine, 3709 UpJohn Center, Box 0504, Ann Arbor, MI 48109.
There has been a significant expansion in the application of regional chemotherapy in the past 20 years, based on increased pharmacologic understanding; improved skills in interventional radiology; the development of reliable, implanted drug-delivery devices; improved monitoring (using computed tomography, magnetic resonance imaging, and nuclide scanning); and insufficient efficacy of systemic chemotherapy for cancer in several important body regions. Regional Chemotherapy: Clinical Research and Practice strives to be a source book on the state of the art in the year 2000. The 22 chapters, all written by experienced practitioners of regional chemotherapy, cover intra-arterial therapy (for hepatic cancers), perfusion therapy (for melanoma and sarcoma), intraperitoneal therapy (for ovarian, gastric, and colorectal cancers), intrathecal therapy (for breast cancer, lymphoma, and leukemia), and intravesicular therapy for superficial bladder cancer.
Nine of the 22 chapters concern various aspects of intraperitoneal cancer, reflecting the editor’s interest and expertise in that area. The five chapters on perfusion therapy provide an interesting insight and broadening perspective to a relatively complex technique practiced in a limited number of centers. The chapter on the role of intra-arterial therapy for colorectal metastases to the liver is especially informative. The four chapters on intrathecal therapy constitute a good review of a standard, well-established practice.
Several chapters are noteworthy because they cover material that has not been widely disseminated. For example, chapter 6 deals with lung perfusion for sarcoma metastatic to the lungs, and chapter 7 presents a well-written and thorough discussion of the concepts and application of regional chemotherapy for pancreatic adenocarcinoma. Chapter 12 focuses solely on biologic intraperitoneal chemotherapy, and chapter 13 addresses intraperitoneal 5-fluoro-2-deoxyuridine.
The book effectively describes how curative potential can be increased when regional chemotherapy is applied. For example, survival may be doubled in patients who have only a few liver-confined colorectal metastases when regional plus systemic chemotherapy is added to the usual surgical resection of these metastases (Chapter 2). In another application of regional chemotherapy, disease-free and overall survival are significantly improved when intraperitoneal chemotherapy is utilized for the treatment of small-volume intraperitoneal ovarian cancer (Chapter 11). Finally, it has long been recognized that there is significant curative improvement from intrathecal prophylaxis for lymphomas and leukemias.
Although the value of regional chemotherapy has been demonstrated for these areas, some readers will be disenchanted by the drawbacks, including toxic effects and complications of the various regional treatments, which are covered extensively in the book. Moreover, regional chemotherapy is generally much more difficult to administer than conventional systemic chemotherapy, and it takes much more commitment from medical care providers. In practice, expansion in the clinical application of regional chemotherapy is constrained by time, cost, and risk/benefit considerations. In addition, the fact that regional chemotherapy fails to address cancer as a systemic disease can cause problems in some instances. It is generally the case that the development of more effective systemic drugs could potentially obviate the need for particular applications of regional therapy (i.e., regional chemotherapy, radiotherapy, or surgery).
It is noteworthy that the authors of the various chapters of this book tend to come to the same conclusions on the current state-of-the-art therapy. First, regional chemotherapy has utility as an aid in achieving local control of selected cancers. Second, systemic therapy may be necessary to treat occult systemic disease when such is likely to exist. Third, further randomized controlled trials are necessary for many of the regional therapies to move beyond the investigational stage into wider applicability.
To the extent that regional chemotherapy is likely to remain a useful adjunct in moving toward curative therapies and in controlling bulk regional disease for the foreseeable future, the information contained in this source book makes Regional Chemotherapy: Clinical Research and Practice a valuable addition and update to the libraries of practicing oncologists and clinical cancer centers.
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