Book Review

Ovarian Cancer: Controversies in management

N Engl J Med 1998; 339:1009October 1, 1998

Article

Ovarian Cancer: Controversies in management
Edited by David M. Gershenson and William P. McGuire. 463 pp. New York, Churchill Livingstone, 1998. $75. ISBN: 0-443-07804-1

Of all the malignant conditions of the female genital system, ovarian cancer causes the most deaths. Unfortunately, little progress has been made in the fight against this cancer, although in the past few years the use of refined and more radical surgical techniques and adjuvant combination therapy have significantly improved survival. Response to initial therapy is the rule, but in the majority of patients progressive or recurrent disease develops after a rather short disease-free interval, usually one of only a few months.

There is a need for a book that furnishes physicians and scientists with new opportunities and refined strategies for clinical decision making and future research in ovarian cancer. Gershenson and McGuire have assembled more than 50 of the world's leading authorities to answer pertinent questions regarding controversies in the management of ovarian cancer. The editors have made their own contributions by including in each chapter a brief introduction and an editorial commentary concerning important new developments in the subject under discussion. Each section concludes with a summary and a reflection on the topics that pertain to the questions it set out to answer. The result is a comprehensive, well-balanced, and engaging treatise.

All the chapters begin with a brief description of the clinical or scientific aspects, or both, followed by the questions put to the authors. Particularly useful are the editors' stimulating commentaries based on open-minded discussions that address various aspects of the management of ovarian cancer, including prevention, early detection, and therapy. In addition to coverage of the conventional topics of surgical, radiotherapeutic, and chemotherapeutic interventions, chapters are included on screening, prophylactic oophorectomy, palliative care, quality of life, surveillance after the discontinuation of therapy, and the clinical relevance of basic research.

The book starts with the current status of screening for epithelial cancer, discusses various chemotherapy and radiotherapy protocols for early- and advanced-stage cancer as well as post-therapy surveillance, and then discusses the clinical application of basic-science investigations. Most important, promising new prognostic or stratification factors to be used in the design of randomized clinical trials are included. Testing of genetic markers, such as BRCA1, and new developments and future directions in gene therapy are also covered.

In actual clinical practice, a good decision results from the use of as much information as possible, including that which is controversial. The editors correctly state that controversy can be contentious and destructive and yet be healthy and illuminating as well. In designing their highly readable and forcefully communicated book, they asked each author to address very specific questions that were meant to resolve controversial issues. As a result, the design of the chapters is astute and every contribution is well referenced.

We found this excellent book to be a valuable source of novel, state-of-the-art information regarding the management of ovarian cancer. It will appeal to a broad spectrum of clinical investigators and basic scientists working in this field and gives the practicing physician a comparative assessment of various new approaches intended to improve the status of patients afflicted with ovarian cancer.

Manfred Schmitt, Ph.D., M.D.
Walther Kuhn, M.D.
Technical University of Munich, 81675 Munich, Germany