Commentary: A return trip to MARS: Less may be more when treating mesothelioma

Our plain-English summary of Commentary: A return trip to MARS: Less may be more when treating mesothelioma, by C.M. Griffin, V.H. van Berkel (The Journal of Thoracic and Cardiovascular Surgery, 2022).

The study

• Authors: C.M. Griffin, V.H. van Berkel
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2022;163(6):1948-1949
• Type of article: Editorial, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a commentary by two surgeons, not an original study. It discussed a prospective multi-institutional study by Hasegawa and colleagues, published in the same journal, of chemotherapy before surgery for malignant pleural mesothelioma. The commentators described the earlier MARS trial: 50 patients were randomized to extrapleural pneumonectomy or no operation after chemotherapy, with no survival or quality of life benefit from surgery. Median survival was 14 months in the surgical group and 19 months in the nonsurgical group. According to the commentary, the Hasegawa study enrolled 24 patients, 20 of them eligible, who received 3 cycles of chemotherapy. Of these 20, 18 had surgery: 15 had pleurectomy/decortication and 3 were converted to extrapleural pneumonectomy during the operation. There were no treatment-related deaths. Median survival after registration was 3.45 years for the pleurectomy/decortication patients. The commentators noted that the study had only 20 patients, had no nonsurgical comparison group and was not randomized. The authors concluded that pleurectomy/decortication may be reasonable after chemotherapy. They hoped that larger ongoing trials, including MARS2, will show better outcomes with a more conservative surgical approach.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commentary (editorial opinion) on another study, with no original data of its own
• Who was studied: No population of its own. The commentary discusses a prospective multi-institutional study by Hasegawa and colleagues in which 24 patients with malignant pleural mesothelioma were enrolled and 20 were eligible for inclusion.
• Exposure: Not an asbestos exposure study. The subject is treatment: 3 cycles of neoadjuvant (pre-surgery) chemotherapy followed by pleurectomy/decortication for malignant pleural mesothelioma, compared in the discussion with extrapleural pneumonectomy.
• Main results:
  • As described by the commentators, the earlier MARS trial randomized 50 patients to extrapleural pneumonectomy versus no operation after chemotherapy and showed no survival or quality of life benefit from surgery. Median survival was 14 months in the surgical group and 19 months in the nonsurgical group.
  • As described by the commentators, a large dataset from Dr Sugarbaker's group reported a median overall survival after extrapleural pneumonectomy of 18 months and a 1-year survival of 67%.
  • In the Hasegawa study, as reported in the commentary, 18 of the 20 eligible patients proceeded to surgery. 15 had pleurectomy/decortication and 3 required conversion to extrapleural pneumonectomy during the operation.
  • In the Hasegawa study, as reported in the commentary, there was no treatment-related mortality. Median survival after registration was 3.45 years for patients who had pleurectomy/decortication.
• The authors' conclusion: The authors (commentators) concluded that pleurectomy/decortication may be reasonable after induction chemotherapy for malignant pleural mesothelioma. They wrote that the Hasegawa study gives some hope that ongoing large trials, including MARS2, will show improved outcomes with a more conservative surgical approach.
• Limitations the authors state:
  • The commentators state that the Hasegawa study's sample of 20 patients may not accurately represent results in a larger population.
  • The commentators state that the lack of a nonsurgical control group makes the Hasegawa results difficult to place in historical context.
  • The commentators state that the Hasegawa study lacks the rigor of a randomized controlled trial.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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