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Cardiothoracic Surgery

UCLA mesothelioma care employs lung-sparing surgery and a unique treatment approach

06/21/2012

CU-Mesothelioma CareThe UCLA Comprehensive Mesothelioma Program offers advanced and innovative treatments to increase the longevity of mesothelioma patients and improve their quality of life. Through meticulous lung-sparing surgery and an innovative approach to follow-up care, UCLA physicians are able to significantly benefit patients with this rare and difficult cancer.

Mesothelioma is a diffuse cancer that is strongly associated with exposure to asbestos. It leads to the development of malignant tumors in the pleura, which lines the chest cavity and covers the lungs. Because mesothelioma is spread throughout the pleura — in contrast to the single localized masses and nodules typically seen in solid tumors — it is very challenging to treat surgically. Though the pleura can be surgically removed, it is not usually possible to remove a margin of healthy cells/tissue around mesothelioma as is typically done in other types of cancer surgery. Cancer cells left behind cause the mesothelioma to re-grow, limiting surgery’s effectiveness in increasing the longevity of these patients.

At UCLA, basic science and clinical research have suggested some unique approaches that are helping to make inroads in the management of mesothelioma.

UCLA’s surgical approach to mesothelioma

UCLA surgeons perform an exacting surgery to remove the visible tumor in mesothelioma patients, leaving behind as little cancer as possible to allow for better management with other therapies. The pleurectomy and decortication procedure preserves the lung, in contrast to the more radical extrapleural pneumonectomy (EPP) performed at many other centers. Leaving the lung intact helps improve the patient’s postoperative quality of life.

Surgery also offers a unique opportunity for additional therapies to be used while the affected area is exposed. One such treatment uses an interleukin 4 (IL-4) toxin. Mesothelioma cells have an unusually high number of IL-4 receptors, so the treatment is effective at selectively targeting the cancer cells.

Following surgery, patients undergo radiation therapy to deliver high doses of ionizing radiation with extreme precision in order to spare nearby normal tissue, including the lung. This highly unusual type of radiation delivery is an area of specialization in UCLA’s Department of Radiation Oncology.

Postoperative mesothelioma care

One of the principles guiding postoperative mesothelioma care at UCLA is that of treating it as a chronic disease, similar to diabetes or hypertension. While we are not able to cure the patient, we can provide maintenance care that slows progression while maximizing quality of life.

This treatment approach was first developed at UCLA and leads UCLA physicians, for instance, to avoid routinely recommending chemotherapy for these patients. They find that the few, highly toxic treatments of chemotherapy frequently are not effective in managing the constant growth of cancer cells in mesothelioma. UCLA physicians prefer other approaches such as low-dose interferon alpha, which can be kept at steady daily levels in the patient’s system to constantly inhibit tumor cell re-growth without producing many side effects.

When tumors do grow back after surgery, UCLA physicians have been highly successful in treating them with cryoablation. Performed as an outpatient procedure that typically takes about four hours, the treatment destroys mesothelioma cells by freezing them. It has been effective and is well-tolerated by patients, with few if any side effects.

Sarcomatiod mesothelioma

About 15 percent of mesothelioma cases are of the sarcomatoid type, which tends to be both invasive and metastatic. As a rule, surgeons will not operate on these patients as the cancer is difficult to remove and the patients have not typically fared well with any treatment. UCLA physicians have developed a unique approach of preoperatively treating sarcomatoid mesothelioma patients with intensive chemotherapy using agents typically used to treat primary sarcomas rather than the usual mesothelioma chemotherapy agents.

A focus on quality of life

Mesothelioma is a rare cancer, with only about 3,000 new cases being treated each year. The low number of cases means that most physicians treat few, if any, of these patients during their careers.

“UCLA has developed a program to treat these unusual tumors — including the very rare sarcomatoid type — that centers on lung-sparing surgery and treating the disease as a chronic illness, focusing on treatments that improve our patients’ quality of life,” explains Robert B. Cameron, M.D., FACS, professor and director of UCLA’s Comprehensive Mesothelioma Program.

UCLA’s approach to mesothelioma care is guided both by recent research and by the experience of its own physicians. UCLA has pioneered the use of therapies, such as immunotherapy and cryoablation, both of which have led to significant advances in the care of mesothelioma patients.

Participating Physicians

Surgery:
Robert B. Cameron, M.D.
Professor of Clinical Cardiothoracic
Surgery and Surgical Oncology
Director, UCLA Comprehensive
Mesothelioma Program
Division of Thoracic Surgery

Medical Oncology:
Olga Olevsky, M.D.
Health Sciences Assistant Clinical Professor
Division of Hematology and Medical Oncology

Radiation Oncology:
Michael Selch, M.D.
Professor of Clinical Radiation Oncology

Radiology:
Fereidoun Abtin, M.D.
Assistant Professor of Radiology
Robert Suh, M.D.
Associate Professor of Radiology

Pathology:
Michael Fishbein, M.D.
Professor, Pathology and Laboratory Medicine
Chi Lai, M.D.
Assistant Professor
Pathology and Laboratory Medicine
W. Dean Wallace, M.D.
Assistant Professor
Pathology and Laboratory Medicine

Anesthesia:
Nir Hoftman, M.D.
Associate Clinical Professor, Anesthesiology
Siamak Rahman, M.D.
Associate Clinical Professor, Anesthesiology
James Moore, M.D.
Clinical Professor, Anesthesiology
Lin Mitchell, M.D.
Associate Clinical Professor, Anesthesiology
Parisa Partownavid, M.D.
Associate Clinical Professor, Anesthesiology
Adam Brown, M.D.
Assistant Clinical Professor, Anesthesiology

Contact Information
UCLA Comprehensive Mesothelioma Program
10780 Santa Monica Blvd., Suite 100
Los Angeles, CA 90025

(310) 470-8980 voice
(310) 470-3742 fax
www.uclahealth.org/Mesothelioma





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