Book Review: Adjuvant Therapy of Cancer--VII

This is the seventh in a well-known series of conference summaries,organized and edited by Dr. Salmon. A perusal of the contentsof these volumes over the past two decades reveals the evolutionof concepts related to combined-modality therapy in cancer. Althoughthe word "adjuvant" remains in the title, many of thetrials reviewed in the current volume involve "neoadjuvant"approaches, in which chemotherapy precedes rather than followslocal treatment, or the use of combined modalities without surgery.

The first portion of the volume (65 of the total 464 pages) isdevoted to "scientific overview and perspectives," includinga discussion of tumor angiogenesis by Folkman and a review ofthe effects of adjuvant tamoxifen on insulin-like growth factor(IGF-I), which could explain the modest benefits observed in sometrials of this drug in hormone receptor-negative patients.

In head and neck cancer, two provocative but inconclusive trailsof simultaneous chemoradiation are presented, as well as an illuminatingpaper by Ensley on the inadvertent impact of selection criteriaon trials of adjuvant therapy in head and neck cancer. (A requirementfor "negative margins" leads to inclusion of more diploidtumors, which are less chemotherapy-responsive.) The lung cancersection is outdated today, reflecting the fact that two ASCO meetingshave taken place since this conference. Based on randomized trialsof which the outcome was not known in March 1933, there is nowstrong evidence for chemotherapy and irradiation vs irradiationalone in inoperable stage III disease, and some evidence of benefitfrom neoadjuvant chemotherapy in patients with stage III resectabledisease.

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 AndersonCancer Center. Of particular interest is the 10-year update ofa large French study, showing a clear advantage for doxorubicin-basedtherapy over CMF in premenopausal women with positive nodes. Follow-upof mature Italian and German randomized studies addressing chemohormonaltherapy and treatment duration is also presented.

The sections od gastric, colorectal, and genitourinary cancersand sarcoma/melanoma are devoted primarily to results of phaseII trials. Of the two overviews provided, that by Alberts on ovariancancer suffers from omission of the outcome of adding paclitaxel(Taxol) to platinum-based therapy, and the meta-analysis of sarcomatrials reaches a positive conclusion that may not be generallyapplicable (eg, many of the trials excluded trunk/abdomen primaries).

Through no fault of the editor or meeting organizers, parts ofthis book have already become dated. Still, it affords a usefulsnapshot in time of the state of a dynamic art, and the volumeis worth having for the comprehensive overviews and mature datasummaries on breast cancer alone.