One of our clients, a 50 year old elementary school principal, was recently treated by Dr. Robert B. Cameron of the UCLA School of Medicine in Los Angeles. The patient was diagnosed with Stage 1 epithelial pleural mesothelioma. Dr. Cameron reviewed all of the options carefully with our client and performed a pleurectomy and decortication.

Dr. Cameron visited with Dr. Sugarbaker at Brigham and Women's Hospital in Boston about the pros and cons of the radical pneumonectomy. There is great concern that the Extrapleural pneumonectomy/intrapleural chemotherapy and postoperative radiation approach (the tri-modal therapy) may not be the best approach for the majority of mesothelioma patients. A question that frequently arises when reviewing the literature is whether the median survival averages of Dr. Sugarbaker's patients, which tends to be greater than the national average, is due to pre-selection factors, that is, the patients Dr. Sugarbaker operates on are early Stage I and may have a significantly longer survival even without surgical intervention.

For patients with stage 1 mesothelioma, the median survival for patients who undergo pleurectomy/decortication is 16-17 months (per Dr. Cameron). This is comparable to Dr. Sugarbaker's data of 21 month median survival and 60% local recurrence.

The other great concern is that once a lung is removed, you can't replace it. What if the other lung is compromised, or invaded by metastatic tumor?

From my review of Dr. Cameron's reports, it appears that he tends to favor a case by case approach. UCLA has had a mesothelioma treatment regimen in the past, but the patient population size was apparently too small to draw any meaningful conclusions from regarding the efficacy of various approaches. Dr. Cameron notes that there are proponents of his approach, both at UCLA and at Memorial Sloan Kettering in New York (Dr. Valeri Rusch). Dr. Cameron would appear to recommend the pleurectomy/decortication (removal of the pleura of the lung or a portion of the surface lung tissue) with intraoperative chemotherapy followed by post operative radiation.

UCLA anticipates new experimental treatment regimens in the near future. These include interleukin-4 based immunotoxin therapy and photodynamic therapy.

Dr. Cameron is a thoracic surgeon at the UCLA School of Medicine. He is the Director of the Thoracic Oncology Program within the Jonsson Comprehensive Cancer Center at UCLA. The Jonsson Cancer Center has been designated by the National Cancer Institute. Dr. Cameron is an assistant professor of Cardiothoracic Surgery and Surgical Oncology at UCLA School of Medicine. His phone number is 310-794-7333.

** POSTED OCTOBER 13, 1997 **