Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Our plain-English summary of Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, by R.A. Stahel, W. Weder, Y. Lievens, et al (Annals of Oncology, 2010).

The study

• Authors: R.A. Stahel, W. Weder, Y. Lievens, E. Felip, ESMO Guidelines Working Group
• Journal: Annals of Oncology
• Published: 2010;21 Suppl 5:v126-8
• Type of article: Guideline
• Cited by: 71 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This clinical practice guideline, written on behalf of the European Society for Medical Oncology (ESMO) Guidelines Working Group and last updated in March 2010, summarised recommendations for the diagnosis, staging, treatment and follow-up of malignant pleural mesothelioma (MPM). The authors described MPM as a rare tumour, with an incidence of 1.25 per 100 000 in Great Britain and 1.1 per 100 000 in Germany, expected to double in many countries within 20 years. They identified asbestos exposure as a well-established cause, with occupational exposure documented in 70%–80% of those affected, and stated that an occupational history must be obtained. Histology including immunohistochemistry was described as the gold standard for diagnosis. Serum mesothelin-related proteins and osteopontin were noted as possible supporting markers whose precise role was yet to be defined. Clinical staging was based on chest CT, and the IMIG staging system and EORTC prognostic scores were discussed. Extra-pleural pneumonectomy, generally combined with chemotherapy and/or radiotherapy, was recommended only for selected patients, by experienced thoracic surgeons, preferably within a clinical trial. Pemetrexed/cisplatin, and to a smaller extent raltitrexed/cisplatin, were reported to improve survival compared with cisplatin alone in randomised trials. The exact role of definitive radiotherapy was described as under investigation. The authors stated that no definitive conclusions could be drawn on the efficacy of prophylactic irradiation of intervention tracts. Recommendations were graded using American Society of Clinical Oncology levels of evidence and grades of recommendation.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a clinical practice guideline from the European Society for Medical Oncology (ESMO) on malignant pleural mesothelioma. It reported no new patient data. It summarised recommendations on diagnosis, treatment and follow-up, graded by levels of evidence. The guideline stated that asbestos exposure is a well-established cause of the disease, with occupational exposure documented in 70%–80% of those affected. It gave incidence figures of 1.25 per 100 000 in Great Britain and 1.1 per 100 000 in Germany, and said incidence was estimated to double in many countries within 20 years. It said an occupational history must be obtained and that tissue examination (histology) is the gold standard for diagnosis. It said surgery, whose appropriateness was still under consideration, should be done only on selected patients by experienced thoracic surgeons within a multidisciplinary team, preferably as part of a clinical trial. It stated that pemetrexed with cisplatin, and to a smaller extent raltitrexed with cisplatin, improved survival compared with cisplatin alone in randomized trials. It said the value of preventive radiotherapy to instrument tracts could not yet be settled.

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: Clinical practice guideline (expert recommendations with graded levels of evidence); an updated version of an earlier guideline
• Who was studied: Patients with malignant pleural mesothelioma in general; no specific study population was examined
• Exposure: Asbestos, described as a well-established cause of malignant pleural mesothelioma, with occupational exposure documented in 70%–80% of those affected; no fiber types are named
• Main results:
  • The guideline gave incidence figures of 1.25 per 100 000 in Great Britain and 1.1 per 100 000 in Germany
  • The guideline stated that incidence is estimated to double in many countries within the next 20 years
  • The guideline stated that an occupational history must be obtained during diagnosis
  • Histology, including immunohistochemistry, was named the gold standard for diagnosis. Of the three main tissue types (epithelial, sarcomatous and mixed), 60% are epithelial
  • The guideline said the appropriateness of surgery was still under consideration. It recommended surgery only for selected patients, by experienced thoracic surgeons within a multidisciplinary team, preferably as part of a clinical trial (evidence level III, grade A)
  • In randomized trials, pemetrexed with cisplatin, and to a smaller extent raltitrexed with cisplatin, improved survival, lung function and symptom control compared with cisplatin alone (evidence level II, grade A)
  • For second-line treatment, the guideline cited one study of 63 patients treated with vinorelbine, which reported a 16% response rate and median survival of 9.6 months
  • Preventive irradiation of instrument tracts has been advocated to reduce tumour spread along those tracts, but clear prospective data were lacking
  • Follow-up was described as clinical evaluation, with attention to symptoms or chest wall recurrence, and chest CT as needed

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, Staging, Asbestos Exposure, Occupational Exposure, Occupational History, Histology, Immunohistochemistry, Mesothelin.

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• SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020) — E. Nadal, J. Bosch-Barrera, et al. (2021)
• Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline Summary — H.L. Kindler, N. Ismaila, et al. (2018)
• Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines — A.M. Schwartz, M.K. Rezaei (2013)
• Malignant Mesothelioma Biomarkers: From Discovery to Use in Clinical Practice for Diagnosis, Monitoring, Screening, and Treatment — J. Creaney, B.W.S. Robinson (2017)

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