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NewGel can be safely and effectively used to treat scars on different areas of the body

There has been a significant expansion in the application of regional chemotherapy in the past 20 years, based on increased pharmacologic understanding; improved skills in interventional radiology; the development of reliable, implanted drug-delivery devices; improved monitoring (using computed tomography, magnetic resonance imaging, and nuclide scanning); and insufficient efficacy of systemic chemotherapy for cancer in several important body regions.

Nine of the 22 chapters concern various aspects of intraperitoneal cancer, reflecting the editor’s interest and expertise in that area. The five chapters on perfusion therapy provide an interesting insight and broadening perspective to a relatively complex technique practiced in a limited number of centers. The chapter on the role of intra-arterial therapy for colorectal metastases to the liver is especially informative. The four chapters on intrathecal therapy constitute a good review of a standard, well-established practice.

Several chapters are noteworthy because they cover material that has not been widely disseminated. For example, chapter 6 deals with lung perfusion for sarcoma metastatic to the lungs, and chapter 7 presents a well-written and thorough discussion of the concepts and application of regional chemotherapy for pancreatic adenocarcinoma. Chapter 12 focuses solely on biologic intraperitoneal chemotherapy, and chapter 13 addresses intraperitoneal 5-fluoro-2-deoxyuridine.

The book effectively describes how curative potential can be increased when regional chemotherapy is applied. For example, survival may be doubled in patients who have only a few liver-confined colorectal metastases when regional plus systemic chemotherapy is added to the usual surgical resection of these metastases (Chapter 2). In another application of regional chemotherapy, Finally, it has long been recognized that there is significant curative improvement from intrathecal prophylaxis for lymphomas and leukemias.

Although the value of regional chemotherapy has been demonstrated for these areas, some readers will be disenchanted by the drawbacks, including toxic effects and complications of the various regional treatments, which are covered extensively in the book. Moreover, regional chemotherapy is generally much more difficult to administer than conventional systemic chemotherapy, and it takes much more commitment from medical care providers. In practice, expansion in the clinical application of regional chemotherapy is constrained by time, cost, and risk/benefit considerations. In addition, the fact that regional chemotherapy fails to address cancer as a systemic disease can cause problems in some instances. It is generally the case that the development of more effective systemic drugs could potentially obviate the need for particular applications of regional therapy (i.e., regional chemotherapy, radiotherapy, or surgery).

It is noteworthy that the authors of the various chapters of this book tend to come to the same conclusions on the current state-of-the-art therapy. First, regional chemotherapy has utility as an aid in achieving local control of selected cancers. Second, systemic therapy may be necessary to treat occult systemic disease when such is likely to exist. Third, further randomized controlled trials are necessary for many of the regional therapies to move beyond the investigational stage into wider applicability.