Surgery for mesothelioma: MARS landing and future missions.

摘要

The first report of the Mesothelioma and Radical Surgery (MARS) trial appeared in the Journal of Thoracic Oncology [1], The objective of MARS was to establish the possibility of allocating patients, at random, to have either extrapleural pneumonectomy (EPP) or no surgical resection. The target -50 randomised patients - was reached in late 2008. Outcomes are not yet available; however, the trial was not powored to prove effectiveness but to address the question of feasibility.In the MARS trial protocol (Fig. 1), patients were allocated to cither trimodality therapy (chemotherapy, EPP and radical hemithoracic radiotherapy) or identical chemotherapy followed by any non-surgical treatment thought appropriate. The trial employed a two-stage consent process. Patients consented to participate in the study for completion of staging, chemotherapy and other work-up (N = 112). The 2-3 months required for chemotherapy between the first and second consent allowed patients and teams to come to terms with randomisation as a means of unbiased allocation. Of the 112 patients, 50 (45%) were eventually randomised. MARS has shown that unbiased allocation to surgery versus no surgery is not impossible - but it is far from easy.