When officials at the Baylor College of Medicine in Houston decided to add the high-profile Lung Institute with a specialty center aimed at malignant pleural mesothelioma, picking a director was pretty easy.
Dr. David Sugarbaker, the renowned thoracic surgeon from Boston, was a natural first choice.
Sugarbaker had carved his reputation as America's foremost authority on mesothelioma cancer through 25 years of groundbreaking work at Brigham and Women's Hospital.
He already was directing the most well-known mesothelioma specialty center in America, but in 2014 he welcomed the opportunity to create a bigger and even better cancer center in Texas.
Sugarbaker is a brilliant surgeon and astute administrator. Some of his patients from Boston already have traveled to Texas to stay under his care — a testament to their loyalty — but that's nothing new for him. He has been attracting pleural mesothelioma patients from across the country for many years.
He has earned the respect of patients and peers as a surgical innovator. He helped develop and refine the extrapleural pneumonectomy (EPP), an aggressive surgery that removes the entire lung, select lymph nodes, parts of the diaphragm and the lining around the heart and lungs.
He has moved the medical community closer to a cure for this rare, aggressive cancer, lowering the EPP operative mortality rate and extending the lives of hundreds of patients.
Sugarbaker played a major role in developing today's popular multimodal treatment approach that includes a combination of surgery, chemotherapy and radiation, often called trimodal therapy.
"He still is the gold standard when it comes to mesothelioma care," said thoracic surgeon Dr. Abraham Lebenthal, who trained under Sugarbaker and still works at both Brigham and Women's and the Boston VA. "He is Dr. Mesothelioma."
In Boston, Sugarbaker helped develop the International Mesothelioma Program, the largest of its kind, attracting clinicians and researchers from around the world. He expects his efforts in Texas to have a similar magnetic effect.
"This was a dream job for me," he said. "But it's not career-changing. It's just a bigger stadium in which to work. My commitment to patients as a caretaker, as a doctor, will be as strong, or stronger, than ever."
Sugarbaker’s work at the International Mesothelioma Program revolutionized the treatment of pleural mesothelioma. In 1992, the Annals of Thoracic Surgery published research led by Sugarbaker on the difficulties of performing an EPP and how the International Mesothelioma Program has overcome the difficulties with their operative techniques. By 1996, Sugarbaker was publishing results from a trimodal therapy study where 74 percent of patients with epithelial cell type and no lymph node metastasis were living two years after diagnosis and 39 percent were alive at five years.
Sugarbaker is first and foremost a surgeon. He conducts surgeries on pleural mesothelioma patients while his colleagues conduct the complementary therapies of chemotherapy and radiation therapy. Because aggressive surgeries for pleural mesothelioma are only appropriate for early stage cases, Sugarbaker primarily works with patients who are diagnosed before the cancer has reached stage IV. Combining chemotherapy and radiation therapy with surgery improves survival for most people with pleural mesothelioma. Surgery typically comes first, followed by chemotherapy at least a month later, and radiation therapy often begins three to four weeks after the second round of chemotherapy. But the order in which therapies are given may vary depending upon the patient. For example, if a patient’s cancer has spread too far to perform an EPP, chemotherapy may be tried first to shrink tumors enough to do the surgery.
Sugarbaker is most known for his skill in conducting an EPP surgery, but he occasionally uses other surgeries to treat pleural mesothelioma. In some patients who are elderly or not in good enough health to handle an EPP, Sugarbaker may perform a pleurectomy/decortication (P/D), which involves removal of the lung lining and cancerous parts of the lung, but keeps the lung intact. A P/D has less risk of complication and a shorter recovery time, but the chance of local cancer recurrence is higher than with EPP.
In addition to using traditional systemic chemotherapy, Sugarbaker has experience in using intrapleural chemotherapy, which applies heated chemotherapy directly into the pleural lung lining during surgery. This localized approach to chemotherapy allows the drug to penetrate tumors at their origin, but the drug cannot reach cancer cells that have spread beyond the lung lining. Sugarbaker found that higher doses of cisplatin used for intrapleural chemotherapy resulted in longer survival for patients who underwent P/D.
External beam radiation therapy is the type of radiation historically used on pleural mesothelioma patients under Sugarbaker’s care. It is typically administered after chemotherapy begins to shrink remaining tumors. Incisions made during surgery are often irradiated as well to prevent cancer from spreading to surgery wounds.
The Lung Institute at Baylor will provide diagnostic and treatment services for most disorders of the lungs. It also will treat disease of the esophagus, chest wall and mediastinum. It includes specialists from medical oncology, surgery, radiation oncology, pulmonary medicine and radiology.
Sugarbaker is directing the clinical and research programs at the Lung Institute. Part of his vision is a comprehensive program that crosses departments and disciplines.
The surgical program will be at Baylor St. Luke's Medical Center. Sugarbaker also will serve as chief of general thoracic surgery at Baylor. Among his clinical interests are video-assisted thoracic surgery, minimally invasive surgery, lung volume reduction surgery and general thoracic surgery.
Sugarbaker attended Cornell University Medical School. He did his residency in surgery at Brigham and Women's Hospital, Peter Bent Brigham Hospital and Hospital for Sick Children, University of Toronto. He received cardiothoracic training at the Toronto General Hospital. He returned to Brigham to start his career and stayed for another 25 years.
"We can help patients even more now," Sugarbaker said. "And that's exciting to me."
Director of Lung Institute, Chief of General Thoracic Surgery, Baylor College of Medicine.
Weill Medical College of Cornell University
Toronto General Hospital