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J Thorac Cardiovasc Surg 2002;124:1074-1077
© 2002 The American Association for Thoracic Surgery

Editorials

Pleural mesothelioma in 2002: Going somewhere very slowly

From Harper Hospital, Thoracic Oncology Section, Wayne State University, Detroit, Mich.

Received for publication April 16, 2002. Accepted for publication May 21, 2002. Address for reprints: Harvey I. Pass, MD, Harper Hospital, Thoracic Oncology Section, Wayne State University, 3900 John R. Suite 2101, Detroit, MI 48201 (E-mail: hpass@dmc.org).

The first 300 words of the full text of this article appear below.

	Introduction

 
See related article on page 1183.

Nothing exasperates a thoracic surgeon more than to be confronted with a mesothelioma. Few such cases are diagnosed per year in the United States, and many of the internists, pulmonologists, and medical oncologists who see these cases refer them to a thoracic surgeon for one purpose: palliation. Thoracic surgeons themselves differ remarkably in their approach to this disease, but the good news is that there is a cadre of individuals, including Lee and associates, ¹ who actually advocate for novel approaches in the management of this beast.

The most objective method to advocate for change in medical practice is to develop trials that, ideally, will set a new standard of care, and for this disease, the credibility of any trial is strengthened when a multidisciplinary approach is used. In this edition of the Journal, Lee and colleagues from the University of California, San Francisco (UCSF), report a multidisciplinary approach to the management of malignant pleural mesothelioma using radical pleurectomy/decortication and radiation in 32 patients. This report, although small, is an enlightening representation of all that is controversial in the care of the patient with the potentially resectable mesothelioma, and many of these issues involve (1) the goals of an operation, (2) patient selection, (3) follow-up methods, and (4) choice of adjuvant therapy. Undoubtedly, there are no standards for these issues that dictate "best practice" for mesothelioma; however, in dissecting the results and recommendations from the UCSF study, the informed reader should be presented with alternative explanations that could be thought provoking.

	Goals of the operation

 
If mesothelioma is an incurable disease, then what are the goals of an operation in the first place? As Lee's group has pointed out, the operation should be a part of a package of multimodal therapies. The operation performed, however, may depend . . . [Full Text of this Article]

Related Article

Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma

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J. Thorac. Cardiovasc. Surg. 2002 124: 1183-1189. [Abstract] [Full Text] [PDF]

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