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Attempts at surgical removal are of no benefit to asbestos cancer sufferers finds trial led by CORU's Tom Treasure

25 July 2011

Patients suffering from cancer of the lung cavity do not survive any longer if surgeons remove the lung and cavity linings, compared with those who do not have this major surgery. That is the conclusion of a ten-year series of studies carried out by a team at UCL and the Institute of Cancer Research led by CORU's Tom Treasure.

In the latest study, to be published in the leading medical journal, The Lancet Oncology, in August 2011 the Mesothelioma and Radical Surgery (MARS) trial team report results of a three-year study of 50 patients suffering from mesothelioma, a cancer of the lungs and lung cavity associated with asbestos. Of these, half were randomly assigned to have a major surgery known as extrapleural pneumonectomy, in which the affected lung, the lung sac and other parts of the lung cavity are removed. This treatment was sandwiched in between two other anti-cancer treatments, chemotherapy and radiotherapy. The other half of the patient group got chemotherapy.

The MARS trial results showed that 18 months after being selected for one or other of the patient groups, only 25% of patients survived, no matter whether they had received the surgery or not.

Professor Tom Treasure says: “Mesothelioma continues to increase in many countries of the world. The kind of surgery on offer is very radical. And when it is sandwiched between chemotherapy and radiotherapy, it is very arduous. It cannot be justified without evidence that it is effective. This has never been previously subjected to the usual standard of proof, a randomised controlled trial. Now that it has, it has failed the test.

“In the United States, half of thoracic surgeons believe that surgery alone can cure mesothelioma. In practice mesothelioma surgery is always combined with chemotherapy and/or radiotherapy although the sequence varies. Ours is the first prospective study to attempt to see if surgical treatment is justified, and it shows this is clearly not the case.

“Our view is that many mesothelioma sufferers are being subjected to painful and very costly surgery for no benefit.”

The MARS study was a randomised controlled trial funded by Cancer Research UK and was a multicentre collaboration run from the Institute of Cancer Research in London. Professor Julian Peto, based at the London School of Hygiene and Tropical Medicine and a world renowned expert on the epidemiology of this asbestos related cancer was joint lead investigator of the MARS trial.

The report is available as an electronic prepublication release from The Lancet Oncology from 1st July 2011.

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