Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma

Our plain-English summary of Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma, by C. Pinto, A. Ardizzoni, P.G. Betta, et al (American Journal of Clinical Oncology, 2011).

The study

• Authors: C. Pinto, A. Ardizzoni, P.G. Betta, F. Facciolo, G. Tassi, S. Tonoli, M. Zompatori, G. Alessandrini, S.M. Magrini, M. Tiseo, V. Mutri
• Journal: American Journal of Clinical Oncology
• Published: 2011;34(1):99-109
• Type of article: Consensus statement
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a very important public health issue. A large amount of data indicates a relationship between mesothelioma and asbestos exposure. The incidence has both considerably and constantly increased over the past 2 decades in the industrialized countries and is expected to peak in 2010-2020. In Italy, a standardized-rate incidence in 2002 among men was 2.98 per 100,000 and 0.98 per 100,000 among women, with wide differences from one region to another. Stage diagnosis and definition may be difficult. Management of patients with MPM remains complex, so an optimal treatment strategy has not yet been clearly defined. The First Italian Consensus Conference on Malignant Pleural Mesothelioma was held Bologna (Italy) in May 20, 2008. The Consensus Conference was given the patronage of the Italian scientific societies AIOM, AIRO, AIPO, SIC, SICO, SICT, SIAPEC-IAP, AIOT, GOAM, and GIME. This Consensus did not answer all of the unresolved questions in MPM management, but the Expert Opinions have nonetheless provided recommendations, presented in this report, on MPM management for clinicians and patients.

In plain English

This article was a consensus report, not a new study of patients. It set out expert opinions from the First Italian Consensus Conference on Malignant Pleural Mesothelioma, held in Bologna, Italy, on May 20, 2008. Panels covered pathology, imaging, surgery, chemotherapy and radiotherapy. The experts recommended thoracoscopy for diagnosing malignant pleural mesothelioma. They said the marker SMRP needed prospective research before use in screening asbestos-exposed groups. They noted that noninvasive staging understaged about 50% of patients. They treated lymph node involvement as an absolute bar to radical surgery, which they said belonged only in referral centers with experienced surgeons. Outside clinical trials, for young patients with potentially operable disease, no other illnesses and good performance status, most panel members preferred cisplatin-pemetrexed before surgery. They gave priority to trial enrollment and also accepted primary surgery. For patients with advanced disease and good performance status, the panel recommended pemetrexed with cisplatin or carboplatin, given for at most 4 to 6 courses. The authors concluded that the consensus did not answer all open questions, citing limited published evidence.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review article presenting expert consensus recommendations from a consensus conference
• Who was studied: No patients were studied. Italian expert panels (pathologists, radiologists, pulmonologists, nuclear medicine physicians, surgeons, oncologists, radiotherapists) gave recommendations on managing malignant pleural mesothelioma, based on tools available in 2008.
• Exposure: Not studied. The article concerns diagnosis and treatment of malignant pleural mesothelioma and mentions asbestos only as background.
• Main results:
  • The panel recommended thoracoscopy for diagnosing malignant pleural mesothelioma and assessing tumor spread within the pleura.
  • The panel said prospective research on SMRP (soluble mesothelin-related proteins) was needed before it could be used to screen asbestos-exposed groups.
  • Noninvasive staging was judged unsatisfactory, with understaging in about 50% of patients.
  • Lymph node-positive disease was considered an absolute contraindication to radical surgery.
  • Radical surgery should be done only in referral centers by experienced surgeons.
  • The panel gave priority to enrolling patients in clinical trials. Outside trials, for patients with potentially operable disease, young age, no comorbidities and good performance status, most panel members preferred 3 to 4 cycles of cisplatin-pemetrexed before radical surgery, followed by postoperative radiotherapy. Primary surgery was also considered acceptable.
  • For patients with advanced malignant pleural mesothelioma and good performance status, the panel recommended pemetrexed combined with cisplatin or carboplatin. For elderly patients and/or those with poor performance status, pemetrexed-carboplatin or pemetrexed alone could be considered.
  • The panel agreed chemotherapy should start early at diagnosis and be given for a maximum of 4 to 6 courses.
  • Radiotherapy alone as a radical treatment was considered impossible. Drain and procedure sites were to be treated with 21 Gy in 3 daily sessions.
  • The panel stated that radiotherapy after extrapleural pneumonectomy could avoid local relapse in most cases.
• The authors' conclusion: The authors concluded that the consensus did not resolve every open question in managing malignant pleural mesothelioma, but that the expert opinions offered recommendations for clinicians.
• Limitations the authors state:
  • The authors noted that the published literature on malignant pleural mesothelioma was limited.
  • The authors stated that the role of second-line chemotherapy was not proven.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Asbestos Exposure.

Related studies

• Second Italian consensus conference on malignant pleural mesothelioma: state of the art and recommendations — C. Pinto, S. Novello, et al. (2013)
• The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations — S. Novello, C. Pinto, et al. (2016)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)
• Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG) — M.A. Hoda, T. Klikovits, et al. (2016)
• Consensus Report of the 2015 Weinman International Conference on Mesothelioma — M. Carbone, S. Kanodia, et al. (2016)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)

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