Meerbeeck, et al, Lung Cancer (2005) 49S1, S123—S127.

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(Redacted text from the article above, which was published as a consensus study by International Association for the Study of Lung Cancer).

4.2. Surgical treatment There was general agreement amongst the panel that the goal of surgery in the management of potentially resectable mesothelioma was to improve local control by maximally debulking the disease. There was no agreement about the optimal type of surgery (pleuro-pneumonectomy, pleurectomy, or pleurodesis), the need for radiation therapy, or the need for combined modalitytreatment incorporating chemotherapy. Several centres have extensive experience with pleuropneumonectomy, radiation therapy and the addition of chemotherapyto these other modalities [15—18]. However, the lack of appropriately designed prospective trials means that it is difficult to be certain how much patient selection contributes to the results seen after treatment.

Recommendations The panel members formulated the following recommendations: 1. A new robust and uniform clinical staging system based on a large database, consisting of a registry of retrospective surgical data, added with prospective collection of clinical and pathological data of new cases.

[Note: MARF had attempted to undertake the clinical database in a grant to UCLA and Dr. Robert Cameron but because certain members on MARF's Science Advisory Panel decided not to participate, the database project was aborted).

2. Further research, ideally comprising multicentre randomized controlled trials, is required to define preciselythe optimal surgical management of mesothelioma. In addition, trials are also required to evaluate the other components of therapy, including radiation therapy and chemotherapy. 3. Extrapleural pneumonectomy (EPP) should only be carried out as part of a prospective clinical trial, in centres with experience in the procedure, and with the support of a multi disciplinary team.

Note: The consensus study reported that there was no basis to argue that the EPP was superior to the Pleurectomy/Decortication. Moreover, they concluded that because of the lack of appropriately designed prospective clinical trials, one could not draw conclusions from data from such institutions because of the influence of patient selection (ie, cherry picking young, early state patients). The Group also found that there was no evidence that multi-modal therapy (surgery, radiation and chemo) actually improved outcomes. The consensus Group consisted of 27 clinicians from across the world, including Dr. Raphael Bueno of Brigham & Women's Hospital (Boston, Mass, USA) and Dr. Sam Armato (Univ. of Chicago, USA).

*** POSTED JANUARY 16, 2006 ***