Head and Neck Cancer: A Multidisciplinary Approach, 2nd Ed

From the New England Journal of Medicine, June 17, 2004
Head and neck cancer is a devastating illness. This year, the disease will develop in about 46,000 people and cause 12,000 deaths in the United States alone. More than 600,000 cases are predicted worldwide. These numbers cannot describe the physical, emotional, and psychosocial damage wrought by head and neck cancer. Extraordinarily debilitating, the disease affects vital functions people use to define themselves in society. Speech, swallowing, phonation, and appearance are substantially impaired by both the malignancy and its treatment. Advanced cases frequently require both extensive surgery and radiation therapy, leaving functional and cosmetic deficits to challenge even the most skilled reconstructive surgeon and speech pathologist. Despite the disease's incidence, the number of legitimate experts in the field of head and neck cancer, which receives only modest federal funding, is substantially smaller than for cancers of the breast, lung, colon, or lymphatic system. (Figure) Ably edited by Harrison, Sessions, and Hong, this book is a tour de force. Experts on the biology, epidemiology, imaging, chemoprevention, and treatment of head and neck cancer contribute first-rate chapters. The book's major thrust is to provide state-of-the-art discussions of current standards of treatment as well as strong reviews of rare tumors that originate in the head and neck, including soft-tissue and bone sarcomas, paragangliomas, tumors of the salivary gland, lymphomas, and melanomas. Emphasizing the anatomical importance of the site of origin in this disease, the book juxtaposes extensive radiographs of different tumors and stages of cancer with treatment recommendations from William Mendenhall, an internationally respected radiation oncologist, and other luminaries, including Drs. Jatin Shah, Gary Clayman, Randal Weber, Jesus Medina, Paul Harari, Dong Shin, and Merrill Kies. Other strengths include stellar chapters on molecular epidemiology and genetic predisposition, the targeting of the epidermal growth-factor receptor, and gene-replacement therapy, all of which represent important future directions for the treatment of this disease. Several leaders are notably absent, however, and consequently their areas of expertise are less well represented. Organ-preserving techniques and the indications for their use, particularly in cancers of the larynx and hypopharynx, could have been emphasized by contributions from other pioneers, as could approaches to intensive concurrent chemoradiation and re-irradiation. Furthermore, the authors of some chapters struggle to integrate surgical, pathological, and molecular prognostic markers, although this deficiency is reduced by a comprehensive chapter on the molecular biology of head and neck cancer. A chapter that systematically discusses the pathogenesis of the disease would have been preferable to the existing segmented information. Finally, a more international focus for a disease that is considered a worldwide public health menace certainly would have been desirable. Major contributions from international experts on this disease and their roles in the pioneering meta-analyses of chemotherapy are underplayed in this otherwise outstanding book. The book's inclusive, multidisciplinary nature is its greatest strength. It flows well; the chapters are readable, concise, and informative. The reference sections are excellent and representative. The book does not advocate individual points of view (e.g., medical, surgical, or radiologic-oncologic), and authors generally cover their assigned topics thoughtfully and thoroughly. Like the rare well-made movie sequel, this textbook in important ways trumps an already excellent predecessor. From my perspective as a physician for whom a major focus is the care of patients with head and neck cancer, this book is at once heartening and informative. It achieves a generational equipoise among authors, combining contributions from rising stars in the field with others from established leaders, often in the same chapter. On balance, this book expertly covers the multidisciplinary management and underlying biology of head and neck cancer, and, given its structure and crisp editing, it sets a daunting standard for its competitors. Fadlo R. Khuri, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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