Maziak, et al, Lung Cancer (2005) 48, 157—169

(excerpts from the above article, for a full review of the article, click here.)

Summary From 1985 to 2004, Group evaluated published articles re management of mesothelioma using surgery. No randomized controlled trials comparing pleurectomy (PL) with extrapleural pneumonectomy (EPP) or comparing surgery with an alternative treatment were identified.

Conclusions: The role of surgery in the management of malignant pleural mesothelioma cannot be precisely defined as the lack of randomized controlled clinical trials makes it impossible to determine whether the use of EPP or PL improves survival or effectively palliates the symptoms of the disease. Future studies of the role of surgery in the treatment of mesothelioma should include evaluations of quality of life.

1. Introduction The two main surgical treatment approaches are pleurectomy (PL) and extrapleural pneumonectomy (EPP). The former procedure generally involves excision ofsections ofthe pleura. The latter procedure is a more aggressive approach, which involves the removal ofall or part ofa lung, as well as the parietal pleura, ipsilateral pericardium, and diaphragm. This evidence summary focuses on the role of surgery, specifically PL and EPP, in the treatment of diffuse and localized malignant mesothelioma, for which, no widely accepted standard of care currently exists.

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5. Conclusions Because ofthe lack of sufficient high-quality evidence on the surgical management of mesothelioma, the Lung DSG opinion is that: . The role ofs urgery in the management of malignant pleural mesothelioma cannot be precisely defined. Specifically, the lack ofr andomized controlled clinical trials makes it impossible to determine whether the use o fEPP or PL improves the survival of patients with malignant pleural mesothelioma or effectively palliates the symptoms of the disease. . In the management of malignant pleural mesothelioma, limited data exist to support the use of chemotherapy and/or radiotherapy for palliation in some patients. .... . All future studies of the role of surgery in the treatment of malignant pleural mesothelioma should report study selection criteria and operative morbidity and mortality data. . Future studies of the role of surgery in the treatment of malignant pleural mesothelioma need to include evaluations of quality of life.

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*** POSTED JANUARY 16, 2006 ***