Book Review

Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician

N Engl J Med 2001; 344:1723-1724May 31, 2001

Article

Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician
Edited by Frank C. Detterbeck, Mark A. Socinski, M. Patricia Rivera, and Julian G. Rosenman. 480 pp., illustrated. Philadelphia, W.B. Saunders, 2001. $135. ISBN: 0-7216-9192-7

Why do we need another book on lung cancer when there are at least four already available? The emphasis on evidence-based medicine is what gives this book a unique approach. The editors have attempted to “present a concise overview of the data regarding lung cancer in a way that can be applied to clinical practice.” They do this by including, within each chapter, simple declarative statements on the topic at hand and the amount, quality, and consistency of the data supporting the statements. For example, with respect to the statement “The risk of lung cancer increases with tobacco exposure in a dose- and time-dependent manner (approximate average adjusted relative risk of 20),” the amount, quality, and consistency of evidence are categorized as “high.” Chapter 1, “Objectives and Methods,” summarizes the approach, and for maximal benefit this chapter should be read first.

Almost all the contributing authors are from the multidisciplinary thoracic oncology team at the University of North Carolina, Chapel Hill, and have worked together closely for some time. This is reflected in the even flow of their approach and writing. They have worked hard to avoid “turf battles and single discipline viewpoints” and have largely succeeded.

The book is organized logically, with chapters on general aspects of lung cancer; early, locally advanced, and advanced non–small-cell lung cancer; limited and extensive stages of small-cell lung cancer; and other types of lung cancer. There are also chapters on extrathoracic and intrathoracic staging. Four chapters deal with pulmonary assessment, surgical treatment, radiotherapy, and chemotherapy. Supportive therapy is covered in the chemotherapy chapter, and neoadjuvant therapy is called induction therapy, which may confuse the unwary reader.

What I missed was photographs. Although the absence of photographs keeps the price of the book down, there is nothing like a well-chosen image to make a point. There is very little discussion of the pathological features of lung cancer and no discussion of the spectrum of carcinoid, atypical carcinoid, and small-cell lung cancer or of the mixed small-cell, non–small-cell histologic picture — both clinical puzzles. Likewise, there is no discussion of the molecular biology of lung cancer, which will probably frame our treatment alternatives in the future. Mesothelioma is not discussed.

The strength of the book is an approach that permits easy understanding of the many confusing areas of lung cancer. Nonexperts can expect to benefit from reading individual chapters. The book will also help pulmonologists, thoracic surgeons, radiation oncologists, and medical oncologists. The book is well referenced and is of manageable size. I will use it, and my fellows would do well to purchase it for their working libraries.

Michael C. Perry, M.D.
Ellis Fischel Cancer Center, Columbia, MO 65203