Is EPP The Answer?

For years in the US the conventional wisdom taught that if you have pleural mesothelioma and you want to survive, you better have your lung taken out.

A new study from the UK has debunked that theory.

Doctors in the UK recently published the preliminary findings from the Mesothelioma and Radical Surgery (MARS) study, a randomized trial in which one group of participants would receive chemotherapy, then extrapleural pneumonectomy (EPP), then radiotherapy. The second group of patients would receive other types of aggressive therapy, but would not receive EPP.

Significantly, the study did not contain an arm for patients to choose or undergo the surgical alternative to the EPP, known as the Pleurectomy/Decortication, which removes the tumor only and spares the lung.

The goal of the trial was to determine whether EPP in conjunction with adjuvant chemotherapy and radiotherapy offered benefits to the patient in terms of life expectancy and quality of life, as compared to other standard therapies. The study also assessed the benefits compared to the surgical risks of morbidity or mortality.

In a nutshell, the MARS trial unambiguously debunked the popular theory that the EPP is the best surgical treatment for pleural mesothelioma patients.

Please read the abstract, as well as the comments by PD pioneer Dr. Robert Cameron of UCLA and the Pacific Meso Center.

Dr. Cameron has been treating mesothelioma patients for over 20 years. He is one of the innovators of the lung-sparing Pleurectomy/Decortication. He has has performed the procedure on over 300 patients in his career. It takes about twice as long as the EPP, is highly tedious, but the results have been worth it in terms of lower patient mortality, above average median survival, and improved quality of life. For more about Dr. Cameron's expertise, click here.

The MARS trial offered up sweet validation of Dr. Cameron's approach -- an approach that has not always endeared him to his pro-EPP surgical colleagues. He writes: "This most recent trial is even more proof that no one suffering from the ravages of mesothelioma should be subjected to the further indignation of a radical, debilitating and useless operation based on "selected" data.”

The take home message: there's no substitute for due diligence. Before consenting to a radical, lung amputating surgery, do your homework. Ask tough questions. And call Dr. Cameron.

December 8, 2010