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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e318292c79f
Letters to the Editor

MARS: A Sense of Perspective and an Inconvenient Truth

Rusch, Valerie W. MD; Kindler, Hedy L. MD

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Thoracic ServiceDepartment of SurgeryMemorial Sloan-Kettering Cancer CenterNew York, New York

Section of Hematology/OncologyDepartment of MedicineUniversity of ChicagoChicago, Illinois

Disclosure: The authors declare no conflict of interest.

Address for correspondence: Valerie W. Rusch, M.D., Chief, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail:

In Response:

Drs. Treasure, Utley, and O’Byrne write to correct what they consider to be misperceptions about the Mesothelioma and Radical Surgery (MARS) trial. Significant concerns about the methodology used in this trial have already been reported by an international group of mesothelioma investigators1 and do not need to be reiterated here. A major concern was that a trial, originally designed to accrue 50 patients with malignant pleural mesothelioma (MPM) to test the feasibility of randomizing between extrapleural pneumonectomy (EPP) versus no surgery, was reported as a definitive phase III trial showing no survival benefit for EPP. This is a fundamental violation of the principles of clinical trial analysis and reporting.

The focus of the article published in the November issue of the Journal of Thoracic Oncology2 and of the accompanying editorial3 was the successful effort by the International Association for the Study of Lung Cancer Staging Committee to develop an international database that would lead to evidence-based revisions of the International Union Against Cancer (UICC) and American Joint Commission on Cancer (AJCC) staging system for MPM. Discussions of the role of EPP in the management of MPM or of the MARS trial are, frankly, tangential to the primary focus of this effort.

Valerie W. Rusch, MD

Thoracic Service

Department of Surgery

Memorial Sloan-Kettering Cancer Center

New York, New York

Hedy L. Kindler, MD

Section of Hematology/Oncology

Department of Medicine

University of Chicago

Chicago, Illinois

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1. Weder W, Stahel RA, Baas P, Dafni U, de Perrot M, McCaughan BC, et al. The MARS feasibility trial: conclusions not supported by data. Lancet Oncol. 2011;12:1093–4

2. Rusch VW, Giroux D, Kennedy C, et al.IASLC Staging Committee. Initial analysis of the international association for the study of lung cancer mesothelioma database. J Thorac Oncol. 2012;7:1631–1639

3. Kindler HL. Robust data: the essential foundation of a revised staging system for pleural mesothelioma. J Thorac Oncol. 2012;7:1623–1624

© 2013International Association for the Study of Lung Cancer


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