Physicians Conclude Unanimously that EPP Should No Longer Be Performed On Patients with Malignant Pleural Mesothelioma

The 1st International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma was held at the Sheraton Delfina in Santa Monica, on Saturday, May 21.  The meeting was chaired by  Dr. Robert B. Cameron who is a board certified cardiothoracic surgeon and trained surgical oncologist specializing in the treatment of malignant pleural mesothelioma who has been involved in the treatment of mesothelioma patients since 1986.  He is the director of the comprehensive mesothelioma program at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) and the chief of thoracic surgery at the West Los Angeles Veterans’ Administration.



A distinguished group of experts from all over the globe, gathered at the Delfina to discuss radical surgery vs. non radical surgery on patients with mesothelioma.  There has been some disagreement among some of the world’s top mesothelioma specialists about the value of using radical surgery, Extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) as opposed to non-radical surgery, Pleural Decortication (P/D).  Dr. Robert B.  Cameron stated that “radical surgeries do not provide a safer margin and that there is no reason to be radical and every good reason to be conservative.   Recurrences are harder to detect when the lung is removed”. 

He went on to say that “the best therapy for mesothelioma has certainly not been defined and that the rationale is to approach things surgically”.  He went on to say that PD is a better procedure than the radial EPP.  “No group that has reviewed the data to date has accepted that EPP is better than PD”. 

(left - right) Mr. David Waller, MD, Mr. Tom Treasure, MD and

Dr. Robert Cameron, MD

Some of the most compelling evidence against EPP came from both Mr. Tom Treasure MD and Mr. David Waller MD, who unveiled their findings from a recently conducted study called the Mesothelioma and Radical Surgery  (MARS) trial in the UK.   Mr. Tom Treasure is professor at Guys Hospital and Mr. David Waller, is consultant thoracic surgeon at Glenfield Hospital in Leicester.  The primary objective of the trial was to review and evaluate the safety and efficacy of EPP for patients with PMP.  It was a randomized trial with 50 patients.  The trialists’ concluded that the results of MARS make it improbable that EPP offers a survival advantage over any less radical forms of treatment.

The other distinguished panel discussed Radiation Techniques, Adjuvant and Neo-Adjuvant Chemotherapy, Immuno-Gene therapy, Veglin and Other Angiogenisis Inhibitors, Interferon Alpha Maintenance Therapy and Palliative Care.