53 Principal results of the feasibility phase of the Mesothelioma and Radical Surgery trial (MARS-feasibility)

Treasure, Tom; Bliss, Judith; Tan, Carol; Entwisle, James; Waller, David; O’Brien, Mary Claire; Coombes, Gill; Webster-Smith, Mark; Kilburn, Lucy; Snee, M.; Thomas, Gill; Darlison, Liz; Lang-Lazdunski, L.; Peto, Julian

doi:10.1016/s0169-5002(11)70053-8

Cited by 5 publications

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“…Estimates of what would have been survival without surgery are difficult to obtain, but without appropriate control data we cannot know what difference surgery makes to survival. Patients eligible for extrapleural pneumonectomy (EPP) within the Mesothelioma and Radical Surgery protocol but randomly assigned not to undergo EPP survived a median of 19.5 months, 2 and that is a longer survival than in reported EPP series in the same epoch. 4,[8][9][10] Statistical analysis of existing data has not resolved the doubt about effectiveness of surgery.…”

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confidence: 99%

What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice

Treasure

2016

The Journal of Thoracic and Cardiovascular Surgery

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Under the banner ''Statistics for the Rest of Us,'' the Journal in 2007 published a critique of case series reports to determine whether surgical resection is effective in improving survival for patients with malignant pleural mesothelioma. 1 The article concluded,''We owe it to today's patients with mesothelioma to get it right. The epidemic is still rising in Europe and there will be many patients in the next 10 to 20 years. We owe it to the rest of the world where asbestos was less well controlled or remains uncontrolled. Equally important is this: we owe it to our own scientific integrity.''There have been some randomized controlled trials, 2-4 but it looks like business as usual-more uncontrolled case series with their inherent limitations.The criteria for observational data to be accepted as evidence have been well described: when an intervention visibly, quickly, and reproducibly alters the course of a disease, cause and effect may be accepted as evident. 5,6 Tension pneumothorax, empyema, cataract, hip fracture, leaking aneurysm, and aortic stenosis are familiar examples. Surgery for mesothelioma meets none of the criteria for acceptance on experience alone. Surgery is performed neither to avert imminent death nor for immediate benefit, nor is cure evident. 7 There are too many biologic and therapeutic variables to determine whether in truth death is delayed; it may even be hastened. Heterogeneity in the progression of the disease provides some patients who naturally survive long without operation, so in the absence of fair comparators it is not possible to confidently attribute the life of any individual patient with mesothelioma to an operation done a year or two previously.At the very least, we should have better estimates of what would be the expected survival of patients, comparable with those operated on, if cared for without surgery. Reports of surgical series have been presaged with gloomy statements that survival is likely to be as short as ''4 to 12 months,'' but From the

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What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice

Treasure

2016

The Journal of Thoracic and Cardiovascular Surgery

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“…In the trimodality therapy setting non-EPP surgeries have demonstrated better outcomes, in terms of both quality of live and survival [22]. Carefully selected patients may benefit from multimodality approach but adequately powered randomized trials are required in order to establish the optimal strategy for the integration of CT and RT with surgery.…”

Section: Multimodality Treatmentmentioning

confidence: 99%

Emerging therapies in malignant pleural mesothelioma

Cinausero

Rihawi

Cortiula

et al. 2019

Critical Reviews in Oncology/Hematology

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“…A valiant but failed effort was attempted by the Mesothelioma and Radical Surgery (MARS) trial. 10 The only solid conclusion to be drawn from the MARS trial is that a randomized trial evaluating EPP versus nonsurgical management is not feasible. That's it!…”

Section: Raja M Flores Mdmentioning

confidence: 99%

Pleurectomy decortication for mesothelioma: The procedure of choice when possible

Flores

2016

The Journal of Thoracic and Cardiovascular Surgery

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53 Principal results of the feasibility phase of the Mesothelioma and Radical Surgery trial (MARS-feasibility)

Cited by 5 publications

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What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice

What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice

Emerging therapies in malignant pleural mesothelioma

Pleurectomy decortication for mesothelioma: The procedure of choice when possible

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