Lung Cancer [antikvár]

Preface Lung cancer is the leading cause of cancer-related death in North America and Europe, and its incidence is rising elsewhere, ensuring an increasing number of lung cancer deaths worldwide. Specialists within many oncologic disciplines are devoting the majority of their practice to the investigation of bronchogenic carcinoma, and it is difficult to keep up with the overwhelming explosion of clinical and benchwork data on the disorder. This cascade of knowledge is being fed by technological revolutions in the individual disciplines, which are employed not only to treat the disease but also to characterize it on the molecular, pathologic, and gross morphologic level. The task for the clinician must be to become familiar with the treatment failures of the past and with the innovative approaches for the future, while the benchwork scientist gradually maps the details of lung cancer cells which could translate into feasible human trials. Despite the frequent occurrence of this devastating illness and its impact on public health, we had reservations when we were asked to consider editing an all-inclusive text on the disease. We were skeptical that a textbook devoted solely to lung cancer would attract a large audience. Every standard medical or surgical texbook has a chapter devoted to the etiology, natural history, and treatment of lung cancer; furthermore, all general oncology textbooks commit considerable space to the subject and are typically written by experts in the field. However, this often means that there is limited space for a detailed discussion of topics which are of particular interest to some readers. Moreover, the "bigger picture" topics, including more aggressive, multimodality therapies, are discussed in a few paragraphs or pages, and rarely is there an in-depth review of the contributions made by basic science investigators. In accepting the challenge to edit a book devoted solely to lung cancer, we agreed that the work should contain contributions from clinicians in all relevant disciplines—surgery, radiation oncology, medical oncology and pulmonology—and should also include contributions from basic scientists working in the field. Upon completion, we wanted the textbook to serve as a comprehensive reference for any individual interested in lung cancer—one that would appeal to the basic scientist as well as the clinician, and would serve to broaden the knowledge base of medical students and primary care physicians, as well as cancer specialists. The downside of any such endeavor, of course, is the latency period of knowledge dissemination, that is, what is presented in an opus when the work begins may be outdated by the time the book comes to fruition. This defect, however, is inherent in every aspect of medicine if one considers how long it can take for benchwork to be translated into clinical protocols, and the interval between Phase I toxicity trials to the acceptance of "standard therapy" after Phase III randomized studies. The editors have attempted to bring to the reader the most recent data through repeated reviews of the manuscripts, and by incorporating updated information from the International Association for the Study of Lung Cancer Seventh World Conference in June, 1994. The uniqueness of this work is the integration of information from the clinical world with the basics of lung cancer biology, which would appeal to preclinical investigators. The editors attempted to do this in a manner which assumed nothing regarding the reader's basic fund of knowledge. In broad brushstrokes, the book establishes a basic foundation of the disciplines, starting with the biology of the disease. This concept extends to the clinical disciplines, with discussions of basic principles regarding surgery, radiotherapy, and chemotherapy. After the groundwork is laid, in-depth discussions of innovative or aggressive treatments are outlined by authors who described these details originally in the literature. The book alludes to the advantages, limits, and results of a multidisciplinary approach throughout, and makes a concerted effort to unite concepts regarding this disease, such that the reader is armed with a greater understanding of the natural history, biology, and treatment options for lung cancer. As with any book, the execution of the feat takes much longer than does the formulation of the concepts to be covered. The editors cannot emphasize enough the attention to detail and the cooperation shown by the contributing authors. All are experts who have made contributions to the study of lung cancer and the care of the lung cancer patient. The editors would also like to express their gratitude to Lippincott-Raven, specifically Stuart Freeman, who was always supportive of this effort, and Eileen Wolfberg, whose skillful coordination between contributors, editors, and Lippincott-Raven kept the project moving without incident. Lung Cancer: Principles and Practice is intended to provide both the practitioner and the trainee with a reference source that will be useful in those moments of frustration in dealing with this disease. The editors' most profound wish is that the material presented will stimulate other investigators to join in the battle, so that future editions will describe therapies which will move the survival curves upward and towards the right. Harvey I. Pass, MD James B. Mitchell, PhD David H. Johnson, MD Andrew T. Turrisi, MD xiii