Stanford performs first PITAC procedure for mesothelioma in North America

In March 2026, Leah Backhus, MD, MPH, Thelma and Henry Doelger Professor of Cardiovascular Surgery at the Department of Cardiothoracic Surgery at Stanford Medicine, performed the first PITAC procedure for mesothelioma in North America in a joint effort with Byrne Lee, MD, from the Department of Surgery. The second case was just performed in May 2026. Stanford Health Care is one of a few centers in the world to offer PITAC to its patients.

“Mesothelioma is a terrible disease. We do not have great treatment options in general, and it is almost universally fatal,” said Dr. Backhus. Advances in chemotherapy and immunotherapy have begun to make an impact, but surgery has always had a more limited role. That is, up until now, with PITAC being a promising treatment option. Mesothelioma is difficult to treat because it grows as a thin, cellular lining/tumor that envelopes the lung, making it hard to remove surgically. Radical surgery is not an option for many patients either because their disease is too advanced or because of competing medical conditions, making them at higher risk for complications. Often patients are only offered palliation of symptoms for their surgical care.

PITAC, or pressurized intrathoracic aerosol chemotherapy, offers a viable surgical alternative to radical resection or simple palliative procedures. It has shown promise in small studies as a means to prolong life beyond simple palliation. “PITAC is between these two extremes. It treats the tumor, but not radically so, and it also provides palliation for symptoms,” Dr. Backhus said. “It’s less risky for patients, and we can offer it to more people.”

PITAC is delivered as a pressurized, fine mist directly into a patient’s chest. Dr. Backhus refers to it as “spray paint chemo” because it lays chemotherapy onto the lining of the lungs like a blanket, where it is absorbed and reaches cancer cells. She performs PITAC using a video-assisted thoracic surgery approach that is minimally invasive, using two small ports to deliver the mist, and a small camera inserted between the ribs to watch the progress. 

One advantage is that PITAC enables a high concentration of chemotherapy to be delivered to an isolated area, reducing exposure to the rest of the body.  

For Dr. Backhus, the fact that this achievement occurred at Stanford is a natural fit with the institution's culture. 

“We like to push the envelope and expand ideas that are on the edges because that is where innovation lives,” she said. “It keeps with the legacy of Dr. Norman Shumway performing the first adult human transplant in the United States, and our department’s reputation for blazing trails.”

Dr. Backus’s first patient had peritoneal (abdominal) mesothelioma years prior, and recently developed pleural effusion, a build-up of fluid in her lungs. In the past, she had HIPEC, or hyperthermic intraperitoneal chemotherapy, a related procedure that also delivers chemotherapy into the abdominal cavity, and did well.

“She was already mentally primed to have this procedure done, and she did great. We couldn’t have asked for a more motivated patient,” Dr. Backhus said. “I saw her recently and her scans were good. She had little disease burden to start with, and we don’t see any evidence of disease now.” Her patient was able to return home within two days after the procedure.

Dr. Backhus classifies PITACs risk as “very low” compared to traditional pleural mesothelioma surgeries that involve radical removal of all sites of tumor, an option that major earlier clinical trials like  MARS 1 and MARS 2 trials show had limited benefits. Pleural mesothelioma surgeries, such as P/D (pleurectomy/decortication) with HITHOC (hyperthermic intrathoracic chemotherapy) are still provided to patients who meet strict criteria and have specific needs. Dr. Backhus and the team are hoping that PITAC can offer similar results but minimally-invasively and with a much shorter recovery time.

Preliminary data supports the use of PITAC for pleural mesothelioma. “It looks like it is treating the tumor and not just treating the fluid,” Dr. Backhus said. A closely related version of PITAC, called PIPAC, pressurized intraperitoneal aerosol chemotherapy, has been used successfully in the abdomen. “Pleural mesothelioma mirrors peritoneal mesothelioma, and there is a lot more data to support pressurized aerosol chemotherapy’s use in the abdomen,” she added. More studies are needed to determine its long-term effectiveness on the lungs. It is an exciting achievement for Dr. Backhus, who, as a thoracic surgeon, focuses her work on improving care and outcomes for patients with lung cancer.

“Mesothelioma is a rare cancer, so few centers outside of big cancer hospitals treat it. This gives us an opportunity to be leaders on the West Coast and throughout North America in the use of PITAC for pleural mesothelioma,” Dr. Backhus said.