Book Review

Squamous Cell Head and Neck Cancer: Recent Clinical Progress and Prospects for the Future

N Engl J Med 2006; 354:883-884February 23, 2006

Article

Squamous Cell Head and Neck Cancer: Recent Clinical Progress and Prospects for the Future
(Current Clinical Oncology.) Edited by David J. Adelstein. 358 pp., illustrated. Totowa, N.J., Humana Press, 2005. $165. ISBN: 1-58829-473-0

Starting with the rarely considered subject of squamous-cell carcinoma of the head and neck in the patient who neither smokes nor drinks and concluding with a broad discussion of palliation, the 21 chapters of this book describe recent advances in this specialty field and prospects for treatment of squamous-cell cancer of the head and neck. The many treatments considered in the book include radical and conservative surgery, external-beam radiotherapy, brachytherapy, combined treatments, chemotherapy, targeted therapy, chemoprevention, and gene therapy. This book is one volume in a series of comprehensive reviews in oncology.

The authors are mainly from North America, with just three chapters contributed by authors who practice elsewhere. Five authors from Singapore review nasopharyngeal cancer, and two authors (one from Switzerland; the other, Australia) cover the fields of postoperative treatment and induction chemotherapy. Each chapter is self-contained, with overlap in just two chapters about induction chemotherapy. The references for each chapter are extensive and relatively recent.

The chapters on surgical treatment discuss issues of concern to all who care for patients with head and neck cancer. One important chapter, in particular, considers the role of laser surgery and the controversial use of piecemeal resection, rather than the traditional en bloc resection. The authors review the evidence in the literature and conclude that there is a need for a direct comparison between laser surgery and traditional treatment — be it radiotherapy for early disease or conventional radical surgery for advanced disease.

Of equal importance to surgical management in everyday practice are the roles of neck dissection in organ-preservation protocols and of salvage surgery after nonsurgical treatment, both of which are well reviewed in the book, including the complications and outcomes. Two chapters address preservation of the voice in patients with carcinoma of the larynx; one is devoted to larynx preservation with the use of surgery, the other to the treatment of stage T3 or T4 cancers with the use of radiotherapy, with or without chemotherapy. Preservation of the larynx does not always equate with preservation of the voice, a fact that is addressed in an excellent chapter about the quality of life. Nasopharyngeal cancer presents its own challenges, which are fully discussed in a dedicated chapter that provides updates of current practice together with descriptions of current techniques used in the field.

Naturally, conformal radiotherapy and altered-fractionation radiotherapy are fully discussed, together with chemoradiotherapy. The chapters addressing these treatments discuss the underlying biology and include an authoritative review of the literature, bringing the reader up to date on the results of the latest randomized, controlled trials. Other chapters are devoted to induction chemotherapy before surgery or radiotherapy; one of these describes the treatment as “the new paradigm of sequential therapy.” The continuing challenge of hypoxia due to radioresistance is discussed in admirable detail, with updates from the literature.

Chemoprevention is important in a field in which multiple primary tumors may occur in the same patient, but advances appear disappointing, and a change in lifestyle is still the greatest contributor to the long-term survival of the patient with head and neck cancer who is cured of the presenting tumor. The chapter on gene therapy is satisfactorily comprehensive, but because the field is complex, the chapter would have benefited from the addition of a simple summary of the important points.

Certainly, this book will be a valuable tool for surgeons and oncologists who deal with head and neck cancer. It would also be a useful addition to any institution's library.

Michele I. Saunders, M.D.
University College London, London W1W 7BS, United Kingdom
michele_saunders@hotmail.com