358 CLINICAL RADIOLOGY

Book Reviews

Cancer Statistics. By R. F. Mould. Adam Hilger, Bristol, 1983. xiv+286 pp. £15.00.

This book contains chapters on the following topics: cancer registries, cancer incidence, cancer prevalence, cancer mortality, cancer survival, cancer treatment success and cure, and factors predisposing to cancer. The chapter on cancer registries includes guidance on the sort of data that ought to be collected by a registry and a description of the computer programs used by one particular registry. Incidence, prevalence and mortality rates are discussed in their appropriate chapters. Techniques such as adjustment for the age structure of a population are defined where appropriate. The chapter on cancer survival describes the life-table method for calculating a survival rate together with the log rank test and the proportional hazards model for comparing the survival experience between groups of patients. Only the final chapter, on cancer treatment and cancer cure, contains some mathematics that clinicians may find bewildering. However, this should not prevent a general understanding of the underlying concepts of cure and treatment success being gained. Several chapters contain flow diagrams to aid computer programming of the calculations described.

In the main, the material is well presented. Generally, the statistical terms and methods are clearly defined. The majority of the less straightforward calculations are illustrated by worked examples. Data and results from a large variety of sources and countries accompany most of the topics covered; hence the book is itself a useful source of data, providing information on patterns of cancer incidence, prevalence, mortality and survival. At least half the data and results are presented in the form of graphs and diagrams which, on the whole, are well done with clear legends and provide a useful tool for the interpretation of the figures. There are two mistakes in formulae on pages 163 and 241. The error on page 241 is in the formula for N(t) which should have an S in the denominator. This does not carry through to any of the other formulae. The other mistake, on page 163, is in the formula on the lower half of the page. Within each pair of square brackets there should only be one 'f'. Some of the figures are a long way from the text referring to them but this may be unavoidable in a book that contains so many diagrams and tables.

To summarise, this is a book that covers a number of the aspects of cancer statistics and provides a useful reference volume for people of all disciplines. About one third of the syllabus for the part I examination for the FRCR is covered. Elementary statistics and clinical trials are not discussed.

Valcrie Blair

Cancer of the Prostate. Clinics in Oncology, Vol. 2, No. 2. Edited by G. P. Murphy. W. B. Saunders, London, 1983. 217 pp., 30 figs. £11.75.

This is No. 2 in Volume 2 of Clinics in Oncology which is published three times a year. This issue summarises the 'state of the art' in the management of carcinoma of the prostate.

There are good reviews of epidemiology and pathological features and interesting accounts of new drugs under development and model tumour systems. However, the chapter on imaging techniques has no illustrations whatsoever, which is remiss, even in an economically produced volume. Hormone manoeuvres are used in the majority of patients with carcinoma of the prostate and it is thus astonishing to find such a short chapter on endocrine therapy (10pp.), whereas chemotherapy is dealt with more fully (17 pp.).

A full account is given of experience with external radiotherapy but the technical details occupying the first 14 pages of the chapter are

superfluous. The detailed description of interstitial implantation will be of particular interest to those who have not had the opportunity to assess the technique. The advice given regarding radical surgery has to be interpreted in the context of treatment policies currently favoured here. Since three of the six members of the Editorial Board work in the UK it is a pity that the authors are all American, thus leaving the reader in this country in some doubt about the management of early tumours.

In general, however, this is a full and up-to-date account of the current position in carcinoma of the prostate and will be of interest to those who are involved in the management of this common malignancy.

V. L. Barley

Biological Bases and Clinical Implications of Tumor Radioresistance. Edited by Gilbert H. Fletcher, Carlo Nervi and H. Rodney Withers. Masson Publishing, New York, 1983. xv+429pp., 172 figs. $95.00.

This volume is based on the Rome Conference on Tumor Radioresistance held in September 1980 and the 52 chapters represent separate contributions from many of the most influential radiobiolog- ists and radiotherapists from both Europe and the United States of America.

Failure to achieve local control with radiotherapy is clearly a problem of paramount importance to all radiotherapists. Traditional- ly, this has been considered under the subject headings of the four Rs of radiology, namely, Repair, Reoxygenation, Redistribution and Repopulation. This volume presents an update of these concepts, showing how data from animal and human studies collected during the 1970s have led to an evolution in radiobiological ideas of relevance to clinical radiotherapy. Emphasis is given to the question of tumour cell hypoxia and its clinical importance. An excellent chapter from Chapman of the Cross Cancer Institute, Alberta reviews evidence for tumour hypoxia, including cell survival assays after radiotherapy, histology, the use of oxygen electrodes, phosphate nuclear magnetic resonance and his own data on binding of radioactivity labelled hypoxic cell sensitisers. Juliana Denekamp of the Gray Laboratory contributes a review of methods of quantifying tumour response as an introduction to discussing the critical question of how effective a hypoxic cell radiosensitiser must be to achieve a detectable improvement in local control using fractionated treatment schedules, when the reoxygenation pattern is likely to influence response to conventional treatments. Further sections deal with radiation effects on normal tissues, including a review by Withers and colleagues on the concept of early and late responding tissues and the practical implications of this to dose per fraction. The final section is a pot pourri of therapeutic approaches to radioresistance, including non-standard fractionation, combined modality therapy, radiosensitisation and protection, hyperthermia and even a review of clinical results of negative pi meson therapy in 96 patients treated at Los Alamos.

Overall, the volume is well presented. The numerous aspects of the subject are discussed fluently and comprehensively and are well referenced. A particularly pleasing feature of the book was the multiplicity of figures showing actual results of key studies, rather than only describing them. A criticism is that publication was some 3 years after the conference. Though this does not detract from the discussion of radiobiological principles, some examples and reference lists would have been better updated. Nevertheless, this book should appeal to all radiotherapists and provides a good platform from which to consider prospectively clinical radiobiology in the 1980s.

A. Horwich