Surgery for mesothelioma: MARS landing and future missions

Our plain-English summary of Surgery for mesothelioma: MARS landing and future missions, by T. Treasure (European Journal of Cardio-thoracic Surgery, 2010).

The study

• Author: T. Treasure
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2010;37(3):509-10
• Type of article: Editorial
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial discussed the first report of the Mesothelioma and Radical Surgery (MARS) trial, a feasibility study testing whether patients with mesothelioma could be randomly allocated to extrapleural pneumonectomy (EPP) or no surgical resection. Patients received either trimodality therapy (chemotherapy, EPP and radical hemithoracic radiotherapy) or the same chemotherapy followed by any appropriate non-surgical treatment. Consent was given in two stages. Of 112 patients who consented to staging and chemotherapy, 57 were reviewed as candidates for randomisation, seven were excluded, and 50 (45%) were randomised. The target of 50 was reached in late 2008. Outcomes were not yet available, and the trial was not powered to show effectiveness. The author explained that earlier claims of longer survival after EPP came from follow-up studies of multimodality therapy that were open to selection bias. He cited later reports: complications in over 60% of patients (Boston); major complications in more than 50% and 3-year survival of 14% (Mayo Clinic); and median survival of 10.2 months with EPP plus intensity-modulated radiotherapy. He noted a growing emphasis on lung-sparing surgery. He discussed whether cure, longer survival or palliation should be the outcome for a future trial. He stated that a planned MARS-2 trial would evaluate total pleurectomy, with respiratory function and quality of life as outcomes. He concluded that MARS showed random allocation was possible, and that "some unbiased evidence is clearly better than none."

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was an editorial, not a new study. The author discussed the first report of the Mesothelioma and Radical Surgery (MARS) trial, which was published elsewhere. MARS tested whether patients with mesothelioma could be assigned at random either to treatment including extrapleural pneumonectomy (EPP) or to the same chemotherapy without surgery. The editorial reported that 112 patients agreed to the first stage and that 50 (45%) were eventually randomised. Survival outcomes were not yet available, and the author stated that the trial was designed to test feasibility, not to prove effectiveness. The author also reviewed other groups' reports on EPP and lung-sparing surgery, and wrote that the emerging view in the literature was that surgical 'cure' is not achievable. The author concluded that MARS showed random allocation was possible but that, because of its size, it may give no definitive answer about EPP and survival. A further trial, provisionally called MARS-2, was planned to evaluate total pleurectomy. The article did not discuss asbestos exposure.

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: Editorial commenting on the MARS feasibility trial (reported elsewhere) and on other published reports of surgery for mesothelioma
• Who was studied: No new population was studied. The editorial described the MARS trial: 112 patients consented to the first stage (staging, chemotherapy and work-up), and 50 were eventually randomised. The randomisation target of 50 was reached in late 2008.
• Exposure: No asbestos exposure was discussed. The treatments compared in MARS were trimodality therapy (chemotherapy, extrapleural pneumonectomy and radical hemithoracic radiotherapy) versus the same chemotherapy followed by any non-surgical treatment thought appropriate.
• Main results:
  • In MARS, 50 of the 112 patients (45%) who entered the first stage were eventually randomised to surgery or no surgery.
  • A panel meeting by teleconference reviewed all 57 patients judged by local centres to be candidates for randomisation after three cycles of chemotherapy. Seven of them were excluded for clinical or patient-preference reasons.
  • Outcomes from MARS were not yet available at the time of writing.
  • The author wrote that the emerging consensus in the published literature was that surgical 'cure' of mesothelioma is not achievable.
  • The author stated that a further trial (provisionally MARS-2) would evaluate total pleurectomy and would include respiratory function and quality of life as outcomes.
• The authors' conclusion: The author concluded that MARS showed that unbiased random allocation of patients to surgery versus no surgery is possible, though far from easy, and that some unbiased evidence is better than none.
• Limitations the authors state:
  • The author stated that MARS was designed to address feasibility, not powered to prove effectiveness.
  • The author stated that, for reasons of statistical power, MARS may provide no definitive answer about the effect of EPP on survival.

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, Extrapleural Pneumonectomy (EPP), Surgical Resection, Trimodality Therapy, Chemotherapy, Staging, Multimodal Therapy, Selection Bias.

Related studies

• Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study — T. Treasure, L. Lang-Lazdunski, et al. (2011)
• Surgery in the treatment of malignant pleural mesothelioma: recruitment into trials should be the default position — A. Datta, R. Smith, et al. (2014)
• Surgery for malignant pleural mesothelioma: why we need controlled trials — T. Treasure, M. Dusmet, et al. (2014)
• Surgery in mesothelioma--where do we go after MARS? — B.I. Hiddinga, J.P. van Meerbeeck (2013)
• Surgery as part of radical treatment for malignant pleural mesothelioma — D.A. Waller, S. Tenconi (2017)
• A systematic review of lung-sparing extirpative surgery for pleural mesothelioma — E. Teh, F. Fiorentino, et al. (2011)

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