Mesothelioma Surgical Survival Survey

After twenty years of representing asbestos cancer patients, we know that patients oftentimes are frustrated by the lack of understandable and easy-to-find information that correlates treatment options, doctors and survival. To help patients get answers, our firm has conducted a survey among the nation's leading thoracic surgeons. We want to thank the surgeons who have to date participated in this unprecedented effort to share data directly with patients nationwide.

The following charts represent information we've received directly from the participating surgeons. We have not edited the responses to our survey, but have posted same "as is." If you are a surgeon, please click on this link to access the survey, and fax it to us at 310-221-8095. We understand that answers about a disease this complex may not neatly fit into the squares on a survey chart. Doctors are encouraged to elucidate, elaborate, or include additional information that you think is necessary for understanding your approach to the disease. We will publish your comments verbatim and without comment.

This is the first effort of its kind to survey mesothelioma specialists and bring together comparative treatment data from the world's best physicians. We hope it will serve as a starting point for open and transparent comparisons. Doctors are listed in the response chart alphabetically.

If you are a patient and do not see your surgeon listed, please ask your surgeon to fill out the survey. This important data allows patients to compare doctors, treatment regimens, and survival times. You can email questions or comments to info@rgwpc.com. If you would like, we will contact your doctor for you.

We are also developing a survey for oncologists and for those offering alternative treatment protocols, and will post it soon on the web site.

Finally, the survey was originally published in Asbestos Magazine (February 2008). Please click here for the article.

Doctor

Location

Hospital

# Mesos
Consult
Per/Yr

# Mesos
Treated
Per/Yr

Est.# of
Mesos
Treated
Career

Est.# of
Depos
For
Mesos
2006

Robert Cameron a

CA

UCLA

75

40

300

6

Raja Flores b

NY

Sloan Kettering

60

50

450

0

David Harpole c

NC

Duke

40-50

40-50

250+

1*

Harvey Pass d

NY

NYU

60

35-45

400-500

3

David Rice e

TX

M.D.
Anderson

80

30

180

3

Larry Robinson f

FL

Moffit

~20

~10

~120

2

Eric Vallières g

WA

Swedish

20

15

~5

Steven Wang h

MD

Johns Hopkins

30

20

100

2

Doctor

EPP

P/D

TP

Surg.
Mortality

Pre-Op
Chemo

Post-Op
Chemo/
Rad

Median
Survival
(Months)

Robert Cameron a

N

Y

Y

<1%

N

Y

18-36

Raja Flores b

Y

Y

Y

1%

Not
Always

Not
Always

20

David Harpole c

Y

Y

Y

5%

Y

Preferred

20-22
w/
trimodality

Harvey Pass d

150

100

N

5% [EPP]

1% [PD]

2% [All mesothelioma patients]

Y

Y

Stage dependent

David Rice e

Y

Y

N

3%

+/-

Y

Stage dependent

Larry Robinson f

Y

Rare

Y

<3%

N

Y

Stage dependent

Eric Vallières g

Y

Y - Rare

Y

4%

Y

Rad.

~24

Steven Wang h

Y

Y - Rare

Y

1%

Y

Y

Stage dependent

* "Always as advocate and treating physician," Dr. Harpole

Footnotes

a

Surgical Criteria: Disease limited to predominantly epithelioid histology in one hemithorax, adequate cardiac and pulmonary function

Surgeon's comments: "Each patient must be looked at individually. Surgical procedure should be tailored to the patients' functional status, extent of disease and type of meso. And must take into consideration patients' goals."

b

Surgical criteria: Able to accomplish a maximum cytoreduction with a mortality <= 5%; independent of age and histology; dependent on functional status.

Surgeon's comments: "Survival rates are stage dependent."

c

Surgical criteria: [for EPP] epithelial or mixed histology verified by Roggli; adequate PFT's with differential ventilation-perfusion scan; normal dobutamine echo without evidence of pericardial involvement; mesothelioma protocol CT with 3-D reconstruction; PET without distant disease; no significant co-morbidity. [for PD] verified pathology, can include sarcomatoid; either significant co-morbidity or T4 disease.

Surgeon's comments: "Duke University sees most of the mesothelioma cases in the southeastern U.S."

d

Surgical criteria: Stage I-II, (occasionally Stage III node neg.), physiologically fit for surgery

e

Surgical criteria: non-sarcomatoid; confined to ipsalateral hemithorax; not N3; no trans-diaphragmatic involvement; estimated post-pneumonectomy FEV ≥ 1.0 1/min/sec; cardiac status healthy. Website: www.mdanderson.org/diseases/mesothelioma.

Surgeon's comments: "The above comments apply to extra-pleural pneumonectomy, not pleurectomy. Comparing survival rates for this disease is MEANINGLESS unless one compares stage-specific survival."

f

Surgical criteria: Predominantly epithelial histology with disease limited to the hemithorax and no obvious nodal involvement. Website: www.mychestsurgeon.com.

Surgeon's comments: "With maintenance interferon therapy median survival exceeds 3 years."

g

Surgical criteria: Fit, early stage, good cardiorespiratory reserves

h

Surgery Criteria: General good health, resectable disease, good heart/lung function, response to chemotherapy

1

Review of 328 patients who underwent EPP, "Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies," J Thorac Cardiovasc Surg. 2004 Jul;128(1):138-46

2

Review of tri-modal EPP in 183 patients, "Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients," J Thorac Cardiovasc Surg. 1999 Jan;117(1):54-63; discussion 63-5. Patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival.

*** POSTED ON FEBRUARY 7, 2008 ***