Surgery for mesothelioma? The debate continues

Our plain-English summary of Surgery for mesothelioma? The debate continues, by H.L. Kindler (The Lancet. Oncology, 2011).

The study

• Author: H.L. Kindler
• Journal: The Lancet. Oncology
• Published: 2011;12(8):713-4
• Type of article: Comment
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this invited comment, the author discussed the debate over surgery for pleural mesothelioma, in response to the Mesothelioma and Radical Surgery (MARS) randomised feasibility study by Treasure and colleagues. She noted that neither extrapleural pneumonectomy (EPP) nor radical pleurectomy/decortication (P/D) removes all microscopic tumour, and that randomised trials are uncommon. She summarised non-randomised data from US referral centres. Three-year survival was 18% among 636 patients who had EPP at Brigham and Women's Hospital (1998–2007). Surgical resection predicted overall survival among 945 patients at Memorial Sloan Kettering (1990–2005). Five-year overall survival was 12% among 663 patients having EPP or P/D at three centres. Phase 2 trials of neoadjuvant chemotherapy followed by EPP reported median overall survival of 16.8 to 23.0 months. In MARS, the target of randomly assigning 50 patients in 1 year took 3 years. Its authors concluded that a larger trial could not be done and that EPP offered no benefit and was potentially harmful. The author agreed on feasibility. She noted that the 14.4-month median survival with EPP was measured from randomisation and that perioperative mortality was somewhat higher than expected. However, she considered the conclusion of no benefit premature from a small feasibility study. She called for future studies using clinical and molecular prognostic factors to select patients for resection, and noted that MARS2 was being designed around P/D.

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 a short commentary, not an original study. It responded to the MARS trial, a small randomised feasibility study by Tom Treasure and colleagues that assessed extrapleural pneumonectomy (EPP) for pleural mesothelioma. The author noted that most clinical evidence on surgery comes from tertiary referral centres treating highly selected patients. As the commentary described it, MARS aimed to randomly assign 50 patients in 1 year but took 3 years. Median survival in the EPP group was 14.4 months, counted from randomisation. Perioperative mortality was somewhat higher than expected. After adjusting for sex, age, histology and stage, patients randomly assigned to EPP had a significantly increased risk of death. The MARS authors concluded that EPP offers no benefit and is potentially harmful. The commentary's author argued that it was premature to draw that conclusion from a small feasibility study. The author wrote that some long-term survivors clearly benefit from surgery and called for future studies that better select patients for surgery. The commentary did not discuss asbestos.

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 comment) on another article, the MARS randomised feasibility study; not original research
• Who was studied: No patients were studied by this author. The commentary discussed the MARS trial (Treasure and colleagues), a small randomised feasibility study of patients with pleural mesothelioma in the UK.
• Exposure: Not an exposure study and asbestos is not discussed. The topic is surgery for pleural mesothelioma: extrapleural pneumonectomy (EPP) and radical pleurectomy/decortication (P/D).
• Main results:
  • As reported in the commentary, the MARS target of 50 patients randomly assigned in 1 year was not achieved; it took 3 years
  • As reported in the commentary, median survival in the MARS EPP group was 14.4 months, measured from randomisation rather than from the start of chemotherapy
  • The commentary stated that perioperative mortality in MARS was somewhat higher than expected
  • After adjusting for sex, age, histology and stage, the MARS authors found a significantly increased risk of death for patients randomly assigned to EPP
• The authors' conclusion: The commentary's author concluded it was premature to judge EPP as offering no benefit from this small feasibility study. The author wrote that some long-term survivors clearly benefit from surgery and that future studies should select for surgery only the patients most likely to achieve long-term survival.
• Limitations the authors state:
  • The author noted that randomised trials are uncommon and that clinical data come mostly from tertiary referral centres treating highly selected patients
  • The author described MARS as a small feasibility study

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, Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Brigham and Women's Hospital, Surgical Resection, Overall Survival, Memorial Sloan Kettering.

Related studies

• Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management — M. Baud, A. Bobbio, et al. (2014)
• 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)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)
• National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma — V. Verma, C.A. Ahern, et al. (2017)
• Surgery for malignant pleural mesothelioma after radiotherapy (SMART): final results from a single-centre, phase 2 trial — B.C.J. Cho, L. Donahoe, et al. (2021)
• A systematic review of lung-sparing extirpative surgery for pleural mesothelioma — E. Teh, F. Fiorentino, et al. (2011)

Browse more research in The Lancet. Oncology, or return to medical research.