Clinical Oncology (1996) 8:341 © 1996 The Royal College of Radiologists Clinical

Oncology

Correspondence Letters are published at the discretion of the Editor. Opinions expressed by correspondents are not necessarily those of the Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author of the paper so that the reply can be published in the same issue.

Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instruction to Authors at the front of the Journal.

Thromboembolic Events with Paelitaxel

SIR - In response to the letter entitled 'Thromboembolic Events with Paclitaxel' by Chan et al. [1], I wish to draw attention to our own experiences in this respect. Twenty-one patients with Grade III and Grade IV astrocytoma were treated with paclitaxel 20 mg/m 2 given weekly during a 6-week course of radiation therapy. Two patients died from acute pulmonary embol- ism. One of these was a 71-year-old man whose fatal event occurred 7 weeks after the completion of treatment. The other was a 72-year-old woman who died during the second week of treatment. One other

patient, a 46-year-old woman, was treated for bilateral deep vein thromboses (DVT) 7 months after completing therapy. The total incidence of thromboembolic events in this series of patients is therefore 14%. Patients with brain tumours have been reported to suffer from a high incidence of thrombo- embolic complications [2] and it is likely that, in at least one of our patients, the thromboembolic event was not related to therapy with paclitaxel. I believe this obser- vation merits reporting, and that the risk of DVT and pulmonary embolism should be evaluated in future studies of the use of paclitaxel in a lower risk patient popu- lation.

References

1. Chan ATC, Yeo W, Leung WT, et al. Throm- boembofic events with paclitaxel. Clin Oncol 1996;8:133.

2. Hamilton MG, Hull RD, Pineo GF. Venous thromboembolism in neurosurgery and neuro- logy patients: A review. Neurosurgery 1994;34:280-96.

K. D. JONES The Manitoba Cancer Treatment and Research Foundation

Winnipeg Canada

Book Review

The Wings of Death: Nuclear Pollution and H u m a n Health by C. Busby. Green Audit Books, Aberystwyth, 1995. Pages: 340; Illustrations: 68; Tables: 27; Price: £10.99; Paperback. ISBN 1-897761-03-1.

The first introductory chapter lays the foundation for the remainder of this book. It is the author's opinion that neither natural background radiation and nuclear fission radiation nor internal and external radiation are equivalent. The implication is that we are immune to natural background radiation because we have grown accustomed to it. The next 290 pages attempt to explain this hypothesis. I found the mechanism difficult to visualize by which a cell can differentiate ionization from one artificial source from that from natural background radiation.

The introduction is interesting for entirely different reasons, such as the quotation from Boice and Land explaining that the increased risk of death from all sources in a study of American radiologists was due to a different type of person choosing radiology! Dr Busby's arguments about science and the role of research are actually well presented. It is true that science is concerned with challenging established theories and views, but it also includes verifying them.

In the chapter on the causation of the cancer, there is an historical section on Dr John Snow's work to establish the cause of Asiatic cholera in London. Snow set out his theory in a book published at his own expense; his work was not appreciated until

after his death. The main tenet of this book is to establish Dr Busby's basic theories. Various experimental results are cited to substantiate these claims, although there is little critical analysis of these results.

In summary, this is a diatribe against nuclear weapons, nuclear power and the scientific establishment. The author is a member of the Green Party and uses this book as a forum for making peripheral political points not limited to the subject of the book. f found these digressions to be somewhat distracting. The author has an individual written style. However, the book does make interesting and compulsive reading, particularly as it provides an insight into the thinking of the antinuclear movement. The author has several hypotheses, which he introduces, often with some unconvincing supporting evidence; in the main he fails to sub- stantiate his case. My advice is that he should do some mathemati- cal modelling of his theory, publish his findings in a peer reviewed journal; then the issue of the second event theory can be disussed in proper debate.

I believe his book will be primarily purchased by people interested in Green issues. I would hesitate to recommend it to readers of this Journal.

K. FAULKNER Newcastle General Hospital

Newcastle upon Tyne