C A N C ER Innovative Approaches Improve Treatment Options for Patients with Mesothelioma Through complex lung-sparing surgery and an innovative approach to follow-up care, UCLA’s Comprehensive Mesothelioma Program is improving the longevity and quality of life of patients with mesothelioma, a rare and difficult-to-treat cancer that has long been associated with a poor prognosis. Mesothelioma is caused by exposure to asbestos. Though it is often mistakenly considered a form of lung cancer, it is actually spread through the pleura — the membrane that lines the chest cavity and covers the lungs. “Mesothelioma is unlike most cancers in that, rather than starting as a nodule that gets larger and then spreads through the body, it tends to grow as a diffuse sheet of cancer cells covering every organ inside the chest,” says Robert Cameron, MD, the UCLA thoracic surgeon who heads the program. “That makes it very challenging to treat surgically.” Because the cancer cells are so diffuse, surgery inevitably leaves some cells behind, he notes, and the cancer eventually regrows. 10 years. For tumors that do begin to grow back after surgery and radiation, the program has developed an approach using cryoablation that destroys the mesothelioma cells by freezing them. “We think this is a major breakthrough,” Dr. Cameron says. “Instead of patients having to receive chemotherapy — a very toxic treatment that may not extend their lifespan — they can get rid of these nodules in a very simple outpatient procedure with minimal complication rates.” Dr. Cameron likens mesothelioma care at UCLA to treating a chronic disease such as diabetes or hypertension and says that given how rare the cancer is, it’s important for patients to be treated at a major center such as UCLA that has experience with the disease and a team approach. “There is no current treatment that will eradicate every cell, but our goal is to help patients live for a long time with their disease while maximizing their quality of life,” he says. To view a video about the UCLA Comprehensive Mesothelioma Program, go to: uclahealth.org/ mesothelioma Many medical centers have sought to treat mesothelioma aggressively by surgically removing a lung, but Dr. Cameron notes that this approach has not been shown to be beneficial to the patient. Instead, his team performs a procedure called a pleurectomy that removes the visible cancerous cells while leaving the lung intact, improving the patient’s postoperative quality of life. After surgery, patients undergo radiation therapy — and at UCLA, a state-of-the-art approach known as TomoTherapy is used to deliver higher radiation doses to the cancer with greater precision, reducing toxic side effects. The UCLA team has also pioneered the use of immunotherapy as a strategy to delay the return of the tumor after the initial treatment. Through ongoing low-dose administrations of the drug interferon alpha, Dr. Cameron notes, tumor regrowth can be delayed in some cases by as long as five-to- X-ray image shows mesothelioma tumor in yellow. Image courtesy of Dr. Robert B. Cameron Vital Signs Spring 2015 Vol. 66 11