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."
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).
Footnotes
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a
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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."
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b
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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."
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c
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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."
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d
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Surgical criteria: Stage I-II, (occasionally Stage III node neg.), physiologically
fit for surgery
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e
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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."
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f
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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."
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g
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Surgical criteria: Fit, early stage, good cardiorespiratory reserves
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h
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Surgery Criteria: General good health, resectable disease, good heart/lung
function, response to chemotherapy
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1
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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
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2
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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.
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