Cancer of the Pleura - Cancer News

Halliburton Says Court Clears Asbestos Settlement

HOUSTON (Reuters) - - Halliburton Co. on Friday said a federal court had signed an order that would end the company's asbestos liability later this month, clearing another hurdle for two of its subsidiaries to emerge from bankruptcy.

The Halliburton subsidiaries, Kellogg Brown & Root and DII Industries, filed bankruptcy in December 2003 to facilitate the $4.2 billion asbestos and silica settlement. That settlement was approved by a bankruptcy court in July.

The U.S. District Court ruling, issued on Wednesday, would free Halliburton, an oil field services company formerly headed by Vice President Dick Cheney, of liability from asbestos lawsuits after a 30 day waiting period ending on Dec. 31, the company said.

On Monday, a bankruptcy judge approved a settlement to end insurance disputes that will result in $1.5 billion in cash funding for a payout fund.

Halliburton said it expects to conclude the bankruptcies by year end and fund its settlement by the end of January.

Analysts said investors were anticipating a smooth exit from the asbestos liabilities, which have weighed on the company's share price for nearly four years.

"The asbestos exposure is virtually done. The stock certainly has been trading as if it were done," said Kevin Wood, analyst with Susquehanna Financial Group in New York.

Halliburton's shares, which were up 1 percent or 38 cents at $38.99 in early afternoon trade on the New York Stock Exchange, have gained 43 percent since mid-August.

The company also said on Friday that a U.S. court ruling on Thursday that derailed Swiss-Swedish engineering group ABB's proposed asbestos settlement for its Combustion Engineering unit would have no impact on its own settlement. (Additional reporting by David Brinkerhoff in New York)

Worries Grow Over Asbestos In Middlesex Court

By Jason M. Scally

December 1, 2004 - Removal of asbestos in the Middlesex County Courthouse has been delayed amid concerns over shoddy removal techniques, Lawyers Weekly has learned.

And as worries over health risks in the building grow, court workers are concerned that they have not been kept abreast of the cleanup plan.

The Division of Capital Asset Management will delay a pending asbestos removal project in the elevators of the courthouse - removal that would have occurred while the building was occupied.

At a public meeting held on Nov. 22, DCAM Commissioner David B. Perini - with Chief Justice for Administration and Management Robert A. Mulligan and officials from the Department of Public Health in attendance - agreed to do an inventory of the entire courthouse before any other interior asbestos removal work is completed on the elevator shaft in order to assess the potential health and safety concerns of the employees. The inventory request was formalized by Chris A. Milne - a Dover attorney who is representing the interests of courthouse employees - after he received documents in response to a Freedom of Information Act that showed a history of unsafe abatement work at the courthouse when employees were present.

Specifically, Milne said he found documents which show that during an abatement of asbestos in the area of the courthouse's parking garage in 2002, there had been breaches of the asbestos containment areas that were later closed with duct tape.

"What that means is there was danger to anyone working in an adjacent area," said Milne. "It raises serious questions where you're going to be doing an elevator shaft … that spans the length of the building [because] at each and every floor, you're going to have people working adjacent to the abatement."

Courthouse employees who spoke to Lawyers Weekly after hearing about the initial results of Milne's inquiry expressed concern that they have not been kept fully informed of the courthouse projects.

However, both Perini and Mulligan said that they have continued to keep courthouse employees informed and would not do any work on the building that would be detrimental to anyone's health and safety.

For more information on this developing story, see next week's issue of Lawyers Weekly. MLW

EnPro Industries, Insurers Settle Asbestos Dispute

November 30, 2004 - EnPro Industries on Tuesday announced that it has reached an agreement to settle the current and future asbestos-related insurance claims of EnPro subsidiaries against the vast majority of its solvent London-market companies.

As a result of the agreement, the London insurance companies and a U.S.-based insurer with policies reinsured through London will pay a total of $76.5 million to EnPro's subsidiary, Coltec Industries Inc., and to an asbestos trust that will be established to resolve asbestos-related claims made against certain EnPro subsidiaries under policies subscribed by the carriers. The amount reflects present value and other negotiated discounts to the total insurance amounts. Coltec will also receive payment of slightly more than $1 million from an insolvent London carrier in connection with the settlement.

EnPro will receive $22 million from the settlement total relating to outstanding amounts for asbestos claims that EnPro asserts are owed to its subsidiaries by the settling insurers. EnPro expects to receive the funds in January 2005. The balance of the settlement total will be contributed to the asbestos trust. The settlement resolves all claims made against the settling London insurance companies by EnPro's subsidiaries.

"With this agreement, we have resolved the disputes that led to the withholding of payments related to asbestos claims against our subsidiaries," said Ernie Schaub, president and chief executive officer of EnPro. "We are pleased with the terms of the agreement, which is the second such agreement we have reached this year. Our insurance reimbursements from these carriers will be up to date when we receive the funds in January, and we are assured the remaining insurance coverage they provide will be available and paid when due."

Meeting to address asbestos concerns

State health officials will talk to Dearborn residents about levels found at a former plant.

By Shanteé Woodards / The Detroit News

DEARBORN - December 1, 2004 - State officials will address concerns surrounding the hazardous asbestos levels previously detected at the former W.R. Grace and Co. plant at a meeting Thursday.

The plant, which closed in 1990, exposed workers to asbestos during its operation, which began in the 1950s, officials said. The Michigan Department of Community Health and the federal Agency for Toxic Substances and Disease Registry are doing consultations on the issue.

Officials said the purpose of the meeting is to address residents' concerns about the facility. The meeting will be held at 7 p.m. at the Arab Community Center for Economic and Social Services. A tool and die shop is located on the property, which is in an area south of Warren and west of Schaefer.

"When doing a public health consultation, we always explain why we're doing the consultation to every member of the community that's interested," said T.J. Bucholz, spokesman for the Michigan Department of Community Health. "We've been aware of (the asbestos) issues for some time and have been researching it for at least a year. The risk to the current tenant or tenants is negligible."

The plant processed vermiculite that was mined in Libby, Mont. Vermiculite is a mineral that expands when heated and is often used in insulation. The vermiculite contained asbestos. Past workers could have carried home asbestos fibers on their hair and clothing, officials said. The Dearborn plant is one of 200 plants around the country to receive vermiculite from Libby stemming from the 1920s.

Exposure to asbestos typically occurs by breathing contaminated air in workplaces that make or use asbestos, as well as buildings being torn down or renovated, according to the Agency for Toxic Substances and Disease Registry. Breathing high levels of the fibers over a long period of time may develop a scarlike tissue in the lungs. Workers from the Environmental Protection Agency are surveying properties in the Dearborn area where vermiculite material from the plant may have been deposited. Residents who believe the material was used in their yards or properties will be asked to fill out an EPA survey form.

You can reach Shanteé Woodards at or swoodards@detnews.com.

Managing lurking dangers of asbestos

Nov 29, 2004 - A leading business pressure group is warning that UK businesses run the risk of being heavily fined if they fail to properly implement an asbestos management plan.

Forum of Private Business (FPB) chief executive Nick Goulding said critical changes have been made to health and safety law this year, including tough new regulations on asbestos management which carry heavy fines.

As it is now six months since the law came into force, it is expected that the Health and Safety Executive will begin to crack down on businesses that have failed to adequately comply with the law.

He said: "It is estimated that some half a million commercial, industrial and public buildings are likely to contain asbestos materials.

"The Health and Safety Executive will expect businesses to have found out if their premises contain asbestos. And, if they do, businesses must have assessed the risk of the fibres being released and must have made a plan to manage that risk.

"The asbestos regulations cover all non-domestic buildings whatever type of business is carried out in them. The regulations also cover the common areas of residential rented properties including halls, stairwells, lift shafts and roofs. It is crucial to point out that if your business occupies a building, whether you own it or not, you are responsible for maintaining and repairing the property."

The FPB has produced a Health & Safety Guide, co-badged by the TUC and endorsed by the Small Firms Enterprise Development Initiative (SFEDI).

The FPB is a pressure group fighting on behalf of private businesses, and represents 25,000 UK-based businesses employing in excess of 600,000 people.

Asbestos: Housed in controversies
Pratap Ravindran
How safe is white asbestos?

ARE chrysotile asbestos (or white asbestos) products hazardous to health? The Chrysotile Asbestos Cement Products Manufacturers Association (CACPMA) asserts that they are not. Mr Arun Saraf, Chairman of CACPMA, has been quoted in The Hindu Business Line (September 24, 2004) as saying: "White asbestos is a naturally-occurring mineral with no harmful effect when used in a controlled manner. Asbestos-related diseases are associated with crocidolite or blue asbestos and other amphiboles. It is not used in India, since its import was banned in 1994."

The Association cites a World Health Organisation (WHO) report which says that the "exclusive use of chrysotile (white) fibre in the manufacture of asbestos cement products is not associated with any excess of lung cancer" — but is discreetly silent on the call by the United Nations Environment Programme (UNEP) for global trade restrictions on the sale of all forms of asbestos. The Association has, further, made any debate on the subject difficult by implying that anyone who expresses doubts about the safety of white asbestos automatically becomes an agent of certain "vested interests" — meaning steel makers!

Activists, however, maintain that they are hazardous. A report by Ms Bindu Shajan Perappadan published in The Hindu (June 3, 2004), says: "Though it is prohibited in 36 countries, India continues to keep at bay a ban on white asbestos, directly resulting in daily exposures of nearly nine lakh construction workers to serious health hazards."

"And though there are reams of paperwork on the matter, the use of white asbestos in India continues, while there is a ban on blue and brown asbestos."

"White asbestos is used mainly for water pipes or as roofing sheets in construction industry. Asbestos dust can be inhaled while drilling, cutting a pipe, repairing, renovating or demolishing a building and its effects are far-reaching, affecting everyone from the person mining it to the ultimate consumer. Clinical reports show that asbestosis, mesothelioma and lung cancer can show up even 25 to 40 years after exposure to asbestos."

The report goes on to quote the environmentalist, Mr Gopal Krishnan of Toxic Links, as saying that although the government is aware of the health hazards associated with white asbestos, "Indian government representatives surprisingly objected to the extension of prior-informed consent to cover white asbestos as a material subject to trade control at the Rotterdam Prior Informed Consent Convention in Geneva in November, 2003." As for the Indian government, its stance on the issue is predictably confused.

It may be recalled that Mr Suresh Ramrao Jadhav, Member of Parliament, had raised the question in Parliament in May 2002, as to "whether the government proposes to shut down asbestos sheets manufacturing units in India as it can cause lung cancer to the workers exposed to it" upon which Dr Raman Singh, the then Minister of State for Commerce and Industry, had answered: "There is no conclusive scientific evidence on harmful effects of asbestos. The units manufacturing asbestos have to follow BIS prescribed safety norms to protect workers against harmful effects of asbestos.

Therefore, it is not desirable to ban production of these sheets." Fair enough. But, on August 18, 2003, the then Union Minister of Health and Family Welfare, Ms Sushma Swaraj, made the following statement in the Rajya Sabha: "Studies by the National Institute of Occupational Health, Ahmedabad, have shown that long-term exposure to any type of asbestos can lead to the development of asbestosis, lung cancer and mesothelioma." And, then again, following the receipt of reports linking the incidence of cancer to the inhalation of asbestos, the Union Environment Ministry had appointed a 12-member committee, headed by the former Joint Secretary, Mr V. Rajgopalan, and currently the Central Pollution Control Board (CPCB) chairperson, to look into the hazardous effects of asbestos. Nothing is known about the findings, if any, of this committee.

Given the diversity and incompatibility of views on the subject, a look at we know for certain about white asbestos:

We know that chrysotile or white asbestos is the dominant form of asbestos in international commerce today. It accounts for about 99 per cent of current world asbestos production.

It is known that a large number of scientists the world over agree that chrysotile is an extremely hazardous material. According to them, clinical and epidemiologic studies have established incontrovertibly that chrysotile causes cancer of the lung, malignant mesothelioma of the pleura and peritoneum, cancer of the larynx and certain gastrointestinal cancers. Further, they say that chrysotile causes asbestosis, a progressive fibrous disease of the lungs. The risk of these diseases increases with cumulative lifetime exposure to chrysotile and rises also with increasing time interval (latency) since first exposure. These scientists dispute the claim that chrysotile asbestos can be used `safely' under "certain conditions." This claim, they say, is simply not accurate.

Comparative analyses have apparently established that chrysotile is two-four times less potent than crocidolite asbestos in its ability to cause malignant mesothelioma — but of equal potency of causation of lung cancer. In fact, the International Agency for Research on Cancer of the WHO has declared chrysotile asbestos a proven human carcinogen.

We know that the sale of chrysotile asbestos has virtually ended in Western Europe and North America because of their recognition of its health hazards. However, asbestos sales remain strong in Japan, across Asia and in developing nations worldwide.

Collegium Ramazzini, an international society globally recognised as an authority on environmental and occupational medicine, has called for an immediate worldwide ban on all sales and uses of all forms of asbestos, including chrysotile. The rationale for this ban is threefold:

• that safer substitute materials are readily available,
• that `controlled' use of asbestos is not possible, and
• that the health risks of asbestos are not acceptable in either the industrialised or the newly industrialising nations.

Finally, alternatives to chrysotile are available in PVC and sheet metal to replace asbestos cement. Substitution of asbestos involves the use of other fibres in the place of chrysotile. The major asbestos-cement product categories worldwide are profiled sheet, flat sheet, and building board, slates, pressure pipes, and moulded goods. Most commonly, PVA and cellulose are used as substitutes, particularly for sheet and slates. Polyacrylonitrile (PAN) substitute fibres do not seem to constitute a promising substitute for pressure pipes because of strength requirements, but alternative materials can be used — unplasticised polyvinyl chloride, for instance.

Prudence dictates that when there is disagreement on the safety of a product or a product category, it should be banned or rigorously regulated by the government till the disagreement is resolved. It is intriguing that the United Progressive Alliance (UPA) Government, which claims to represent the interests of the common man, has chosen not to exercise prudence with regard to the production and use of white asbestos products in India.

Asbestos violations reported

EPA says Lee schools need to fix problems

By DAVE BREITENSTEIN
dbreitenstein@news-press.com

November 30, 2004 - The Environmental Protection Agency has found Lee County schools in violation of five asbestos regulations following a June 2003 inspection of district facilities.

Violations include possible asbestos exposures to non-district employees working on renovation projects and the failure to hire an outside air quality firm to give the all-clear after remodeling an asbestos-laden building. Two violations cite the absence of paperwork and another notes the lack of regular inspections.

EPA Toxic Substances Chief Mark Fite has given Lee 30 days to provide written proof that all violations have since been corrected. The federal agency could later decide to impose a $5,500 per day, per violation civil penalty if the district fails to provide evidence of completion.

An EPA official initially visited Lee County 17 months ago on the heels of a complaint lodged by former safety director Ernie Scott, who since has sued the school district and won a $400,000 judgment in a whistleblower lawsuit. The complaint cited asbestos and air quality problems at three schools — North Fort Myers Academy for the Arts, Villas Elementary and Dunbar High — along with the Gwynne Building, which houses school choice offices.

The five violations cited in the 10-page EPA report are:

• Failing to ensure that short-term workers were notified of where asbestos was located.

• Failing to conduct facility surveys every six months for buildings that contain asbestos.

• Failing to submit paperwork for construction projects at Villas Elementary and Dunbar High, which both contain asbestos.

• Failing to maintain records of schools with asbestos in a centralized administration office and at the school.

• Failing to contract with an independent air sampling expert after removing asbestos at North Fort Myers Academy for the Arts.

Lee Superintendent James Browder did not return a call seeking comment.

Nearly every public school building constructed before the mid-1970s contains asbestos, according to Armando de Leon, director of plant management. Lee schools mentioned in the EPA report were all being remodeled a few years ago.

"Any of the asbestos in schools is absolutely harmless, unless it is disturbed," de Leon said. "None of it is in any way, shape or form dangerous to our students."

Scott argued during his court case earlier this month that his position was cut after he spoke out against the district's safety errors and reported violations to state and federal authorities. He testified that contractors working on Dunbar High drilled into asbestos tiles to install wiring for sprinklers and smoke detectors, relying on other non-district employees to sweep the toxic material off the floor without even wearing masks.

"There were over 50 exposures in that three-room area," Scott said.

Scott blamed W.G. Mills, Gulfpoint Construction and Owen-Ames-Kimball for a series of safety errors. All three firms still work with Lee County schools.

North Fort Myers Academy was forced to delay a ceremony dedicating its refurbished building because asbestos issues still lingered, but Principal Doug Santini said he hasn't heard of any concerns from parents or staff since he took the helm last year.

Alimta®/Cisplatin Combination Approved for Malignant Pleural Mesothelioma

Alimta® (pemetrexed) in combination with cisplatin (Platinol®) was recently approved by the United States Food and Drug Administration (FDA) for the treatment of inoperable malignant mesothelioma. Alimta®/cisplatin is the first and only drug regimen proven to improve the duration of survival for patients with advanced malignant mesothelioma.

Malignant pleural mesothelioma is a rare cancer that develops in the tissues that comprise the lining of a lung (pleura). The majority of individuals who develop malignant pleural mesothelioma have experienced chronic exposure to asbestos during the course of their lives. This type of cancer is considered to be resistant to most therapies, which consist of surgery, chemotherapy and/or radiation therapy. Patients with this disease often have a decreased quality of life from symptoms caused by the cancer, such as shortness of breath, cough, pain, fatigue and the inability to eat. Unfortunately, patients typically are not diagnosed with mesothelioma until the cancer has spread to distant sites in the body. Patients with this advanced form of mesothelioma often are not eligible for surgery. Advanced mesothelioma is often treated with chemotherapy in order to improve quality of life or duration of survival for these patients.

The trial that prompted FDA approval of the Alimta®/cisplatin regimen for patients with malignant mesothelioma who are not eligible for surgery involved the direct comparison of the addition of Alimta® to cisplatin, versus cisplatin alone. Patients treated with Alimta® also received daily vitamin B12 injections and folic acid supplements, in order to reduce side effects. The trial included nearly 450 patients from 19 countries who had inoperable mesothelioma and were treated with either Alimta®/cisplatin or cisplatin alone. Overall survival was increased by 30% in the group of patients treated with Alimta®/cisplatin (21.1 months), compared to the group treated with cisplatin alone (9.3 months). Furthermore, one-year survival rates were 50.3% for patients treated with Alimta®/cisplatin, compared with only 38% of patients treated with cisplatin alone. Lung function was also improved with in the group of patients treated with Alimta®/cisplatin compared to those treated with cisplatin alone. Side effects associated with Alimta® included low levels of blood cells, nausea, vomiting, diarrhea, pain, skin rash and fatigue.

Patients diagnosed with malignant mesothelioma may wish to speak with their physician about the risks and benefits of a treatment regimen including Alimta® . Alimta® is also in clinical trials evaluating its effectiveness in the treatment of different types of cancer.

Reference: Eli Lilly and Company. FDA approves Alimta-cisplatin combination for treatment of asbestos-related cancer. Available at: http://newsroom.lilly.com/news/Product/2004-02-05_alimta_usapproval.html. Accessed February 2004.

Q&A: Latest Treatments for Mesothelioma

Researchers are studying whether chemotherapy before surgery and radiation can deter tumor recurrence in patients with mesothelioma, a rare cancer of the lining of the chest caused by asbestos exposure.

The study builds on the success of a previous clinical trial at M. D. Anderson that included surgery called extra pleural pneumonectomy (EPP), which involves removal of the affected lung and lining of the chest, followed by a highly specialized form of radiation therapy known as Intensity Modulated Radiotherapy (IMRT).

The new multi-center study, which will recruit 77 patients nationwide, will involve EPP, post-operative IMRT and the chemotherapy drugs pemetrexed (Alimta®) and cisplatin, says Katherine Pisters, M.D., principal investigator on the study at M. D. Anderson and associate professor in the Department of Thoracic/Head and Neck Medical Oncology.

The other trial locations are:

Memorial Sloan-Kettering Cancer Center, New York
University of Chicago, Chicago
Johns Hopkins Hospital, Baltimore
Barbara Ann Karmanos Cancer Institute, Detroit
University of Pennsylvania, Philadelphia
Brigham and Women’s University, Boston
Many of the sites already have begun studying the use of chemotherapy prior to surgery and radiation. The chemotherapy combination of pemetrexed and cisplatin was approved by the Food and Drug Administration (FDA) for treatment of mesothelioma after the drugs were shown to prolong survival.

Answering questions about both studies are Pisters, Craig Stevens, M.D., Ph.D., principal investigator on the previous M. D. Anderson trial and associate professor in the Division of Radiation Oncology; and David Rice, M.D., surgical principal investigator on the new study and assistant professor in the Department of Thoracic and Cardiovascular Surgery.

What is unique about this study?

Pisters: This is the first mesothelioma trial to explore the use of chemotherapy before surgery and radiation.

How does the new trial build on the previous study?

Stevens: Our previous trial involving extrapleural pneumonectomy and IMRT was more than 90% effective in preventing a local recurrence (return of the cancer to its original site). However, 50% of those patients experienced recurrence in a different location, usually the other lung, abdomen or another part of the body. M. D. Anderson will be the only center employing IMRT rather than conventional radiation therapy.

Pisters: We are now adding chemotherapy before surgery and radiation to decrease the possibility of distant cancer metastasis (spread to an area away from the original site). We are using pemetrexed and cisplatin because they already have been shown to be effective in metastatic disease.

How has this chemotherapy been found effective?

Stevens: Pemetrexed and cisplatin were shown to prolong survival by three months in mesothelioma patients with advanced disease (when the drugs were taken together, compared to if cisplatin was taken alone).

What does each component of the trial involve?

Stevens:

Pemetrexed (Alimta®) and cisplatin – Chemotherapy drugs given before surgery.

Extrapleural pneumonectomy (EPP) – Surgery to remove the lung, lining of the chest, diaphragm and pericardium, which is the sac that contains the heart. The diaphragm and pericardium are reconstructed with prosthetic material.

Intensity Modulated Radiotherapy (IMRT) – High-precision radiation that delivers multiple beams of radiation to tumors or areas within a tumor. This technique can deliver radiation to very irregularly-shaped targets, like those found after EPP. Other centers involved in this study will use more conventional forms of radiation.

What are the benefits of this surgery?

Rice: The only thing that has ever been shown to lead to any long-term survival has been extrapleural pneumonectomy followed by some form of post-operative treatment, usually radiation alone or a combination of chemotherapy and radiation.

Why is it necessary to remove the lung and other organs?

Rice: Mesothelioma starts in the parietal pleura (the lining of the inner chest wall and lining that covers the diaphragm) and grows into the visceral pleura (lining that covers the lung). It is almost impossible to separate the visceral pleura from the lung in order to remove the cancer, so the lung must be removed. In addition, mesothelioma frequently invades the lung tissue, so for complete removal of the tumor, the lung must be removed.

The tumor usually abuts the diaphragm and pericardium, so to completely remove all of the cancer we have to remove those structures. Then we reconstruct the diaphragm and the pericardium. It is a big operation and takes anywhere from four to six hours. Patients undergo the operation only after careful pre-operative evaluation that involves surgical staging (minor surgical procedures to determine the extent of the disease), as well as careful testing of lung and heart function. The staging done in the first trial was important because it eliminated 12% of the patients who were ineligible for surgery due to advanced disease.

Stevens: The other reason to remove the lung and diaphragm is to prevent breathing motion of the radiation targets. Accounting for such motion is very difficult. Accounting for the motion incorrectly will lead to more tumor recurrence.

What is life like for people with one lung?

Rice: It is very difficult to predict. Most people have a mild to moderate degree of shortness of breath (also one of the symptoms of the disease before surgery.) Because the surgery involves a very large incision and we occasionally have to take portions of the ribs out, many patients have a fair amount of pain immediately after surgery. But we are usually able to control it well with pain medication.

Sometimes, particularly with patients who have excruciating pain related to the tumor growing through the chest wall, if we can get that tumor out, the pain does improve. Paradoxically, some patients seem to breathe even better after we remove their affected lung. The reason for this is probably relief of tumor compression on the lung and the associated restriction of chest wall movement.

What was the survival rate in the previous trial?

Stevens: Out of 55 patients, we had only one infield failure (cancer returning within an area that received radiation). Most of our patients are more than two years out from treatment. In comparison, most patients without radiation have an 80% fail rate within nine months. With more “conventional” radiation approaches, about one of three patients fail in the irradiated regions.

How was IMRT able to be as precise as it was in the previous trial?

Stevens: During EPP, the surgeon implants titanium clips in the chest to mark the areas where mesothelioma tumors are located. We can see the clips on X-ray and can then pinpoint where the cancer was and irradiate that area with IMRT. The clips are critical, and the way the diaphragm is reconstructed is really important. The diaphragm is reconstructed with Gore-Tex®, a material that we can see on X-ray that allows us to better tailor the radiation beam to that patient. During surgery the (reconstructed) diaphragm is pulled tight so that the abdominal contents are pushed as far out of the radiation field as possible.

How many cases of mesothelioma will be treated in the United States this year?

Rice: There are expected to be approximately 3,500 cases, but that number will increase and peak in the next several years because of asbestos controls in the 1970s and the 20- to 40-year period between the time asbestos exposure begins and mesothelioma develops. It also is not clear how large amounts of asbestos released during the World Trade Center disaster will impact future mesothelioma incidences.

Although we have an estimation of the number of people who will be diagnosed with mesothelioma, it is not known exactly how many of those patients will be actually treated because there is probably a large number of patients with mesothelioma who are misdiagnosed as having metastatic adenocarcinoma (another form of cancer).

In addition, there is generally a nihilistic attitude about this disease in the medical community, and it is likely that many patients are not referred to centers where potentially curative treatment may be given.

Although we are far from having a cure for all patients with mesothelioma, the recent development of more effective chemotherapeutic agents, radical surgery and advanced radiotherapeutic modalities now at least offers a glimmer of hope to patients suffering from this devastating disease.

For more information about the new mesothelioma study at M. D. Anderson involving pemetrexed and cisplatin, EPP and IMRT, contact research nurses Li Ling Hwang or Jean Riddle in the Department of Thoracic/Head and Neck Medical Oncology at (713) 792-6363.

Shipbuilder Survives Mesothelioma

Cancer Treated With Aggressive Surgery, Precise Radiation

John Ross built ships for 15 years, unknowingly exposing himself to agents that caused a rare form of cancer called mesothelioma.

In the early 1980s, he was diagnosed with asbestosis, a condition that scars the lungs and creates breathing problems. He had come to terms with that, but never realized that the same exposure to asbestos also could cause cancer.

It took a long time for doctors to diagnose his heart attack-like chest pains as mesothelioma. Eventually, Ross’ search for answers led him to a clinical trial at M. D. Anderson involving an aggressive surgery and high-precision form of radiation.

“So few people know about mesothelioma, really, and it is a deadly disease,” says the Biloxi, Miss. native, who completed his last radiation treatment in April 2003.

Diagnosis for cancer elusive

His symptoms began years before, in 1996, with a sporadic, crushing feeling in his chest. These mysterious chest pains occurred regardless of what he was doing, although he would sometimes go without an episode for up to three months.

“I was just an ordinary guy, no other sickness, no nothing at all in my life,” Ross says. “And then this thing here (mesothelioma) comes along, and here I was. I didn’t know what was happening to me. I kept having (what I thought were) heart attacks.”

Ross went to the hospital, where doctors could find nothing wrong. Several hospitals later, doctors still had no idea what was causing the chest pains. After countless tests, some physicians thought he was pretending, Ross says.

His doctors back home told Dorothy, his wife of 58 years, that there was nothing they could do for him, and said all she could do was make him comfortable. But he continued his quest for answers.

Treatment involves removal of lung

A year and a half later, at the age of 76, he was diagnosed with mesothelioma at M. D. Anderson and enrolled in a clinical trial.

The study included a surgery called extrapleural pneumonectomy (EPP), which, due to the extent and location of the cancer, involved removing his lung, lining of the lung, diaphragm and pericardium (the sac that contains the heart). Several weeks later he began 25 treatments of Intensity Modulated Radiotherapy (IMRT). The highly focused radiation targeted tumors without harming the surrounding healthy tissue.

Side effects following treatment have been difficult for Ross. An infection following surgery resulted in loss of hearing. He now is able to hear somewhat, thanks to cochlear implants in one ear.

Through it all, Ross keeps a positive attitude. He still enjoys fishing and making model sailboats in his home workshop. He also focuses on the good news from his follow-up medical visits, which has all been positive. “I’m a miracle man,” he says, smiling.