Thursday, April 1, 2010

Treatment Centers

* Manjit S. Bains, M.D., F.A.C.S., Thoracic Surgery at the Memorial Sloan-Kettering Cancer Center in New York City.
* Robert Cameron, M.D., Director of Thoracic Oncology at the University of California at Los Angeles (UCLA) School of Medicine.
* Philippe A. Chihanian, M.D., Mount Sinai Hospital, New York City.
* Mark Cullen, M.D., Directory of the Yale Occupational and Environmental Medicine Program at Yale University School of Medicine, New Haven, Connecticut.
* Jack A. Elias, M.D., Chief of Pulmonary and Critical Care Medicine Section, Yale University School of Medicine, New Haven, Connecticut.
* Bruce G. Haffty, M.D., Therapeutic Radiology, Yale Cancer Center, New Haven, Connecticut.
* Graeme L. Hammond, M.D., Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
* David Jablons, M.D., Chief of General Thoracic Surgery at the University of California in San Francisco (UCSF) Medical Center.
* Theirry Jahan, M.D., 2356 Sutter Street, 7th floor, San Francisco, CA 94115 (415) 567-5581.
* Larry Kaiser, M.D., Chief of the Thoracic Oncology Research Laboratory at the University of Pennsylvania Medical Center in Philadelphia.
* Heddy Lee Kindler, M.D., University of Chicago Hospitals, 5841 S. Maryland Avenue MC 2115, Chicago, IL 60637. (773) 702-0360
* Mark Lischner, M.D., 2 Medical Plaza, Suite 100, Roseville, CA 95661 (916) 786-7498.
* Harvey I. Pass, M.D., Chief of Thoracic Oncology at the Barbara Ann Karmanos Cancer Institute in Detroit, Michigan. (This Institute is associated with Wayne State University.)
* Carrie A. Redlich, MD, MPH, Associate Professor of Occupational and Environmental Medicine, Yale University School of Medicine, New Haven, Connecticut.
* Lary Robinson, M.D., Director of the Division of Cardiovascular and Thoracic Surgery and the principal Thoracic Surgical Oncologist at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida.
* Valerie Rusch, M.D., F.A.C.S., Alfred P. Sloan Chair at the Memorial Sloan-Kettering Cancer Center in New York City.
* David J. Sugarbaker, M.D., Chief of the Division of Thoracic Surgery at Brigham & Womens Hospital in Boston, Massachusetts.
* Paul Sugarbaker, M.D., at the Washington Cancer Institute in Washington, D.C.

Radiation Therapy

This treatment involves the localized use of high-dose radiation (like x-rays) on malignant tumors. Usually, it is not a primary treatment but is used in conjunction with other therapies such as surgical resection and chemotherapy. It is generally used to reduce the size of the symptomatic tumor and help relieve symptoms like pain and shortness of breath.

Factors which can limit the application of this treatment include the volume of the tumor and how near it is to vital organs.

Mesothelioma Treatment Options - Surgery

There are two main types of surgical treatment for pleural mesothelioma: extra-pleural pneumonectomy (EPP) and pleurectomy/decortication.

EPP involves the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. Pleurectomy/decortication involves the removal of the pleura without removing the entire lung.

Which treatment is recommended depends on many factors, including the stage of the tumor. (The NCI has a detailed description of mesothelioma stages.) However, it is unclear if EPP provides significantly greater benefits than pleurectomy/decortication, and indeed if either is significantly more effective than non-surgical options.

A recent study followed about 400 mesothelioma patients who, between 1983 and 1998, had pleurectomy/decortication, or extra-pleural pneumonectomy (EPP), or thoracotomy. The results indicate that no one type of surgery was more effective than another in extending the survival rate. Rather, other factors seemed to determine how long people survived. These factors included the stage and cell type of the tumor, the gender of the patient, and the type of treatment(s) given together with the surgery. Click here for the text of this study.

Surgery can provide symptomatic relief and sometimes the bulk of the tumor can be removed. Surgery is often used in combination with other treatments (known as multi-modal treatments), but its value is very limited if the tumor is near any vital organs.

Both EPP and pleurectomy/decortication are complex surgeries, not performed frequently by most surgeons. They require referral to centers dedicated to such treatments. Many of these centers also specialize in other forms of mesothelioma treatment, either alone or in combination (multi-modal therapy.) You should discuss referrals with your doctor. See also: "The effect of extent of local resection on patients on patterns of disease progression in malignant pleural mesothelioma," by D.J. Stewart, et al in Ann. Thorac Surg., July 2004; 78(1):245-252.