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 P. Baas, D. Fennell, K.M. Kerr, et al (Annals of Oncology, 2015).

The study

• Authors: P. Baas, D. Fennell, K.M. Kerr, P.E. Van Schil, R.L. Haas, S. Peters, ESMO Guidelines Committee
• Journal: Annals of Oncology
• Published: 2015;26 Suppl 5:v31-9
• Type of article: Guideline
• Cited by: 241 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This article presented the European Society for Medical Oncology (ESMO) clinical practice guidelines for the diagnosis, treatment and follow-up of malignant pleural mesothelioma (MPM), last updated in July 2015 and replacing the 2010 version. The expert authors selected the relevant literature and graded their recommendations using levels of evidence and grades of recommendation adapted from the Infectious Diseases Society of America-United States Public Health Service system. The authors reported incidence rates in males of 3.4/100 000 in Great Britain, 2.3/100 000 in France and 3.2/100 000 in the Netherlands, and stated that occupational asbestos exposure accounts for more than 80% of cases. They recommended taking an occupational history with emphasis on asbestos exposure, CT scanning of the thorax, and obtaining a pathological specimen in patients with unilateral pleural thickening. They stated that there is no place for screening of persons exposed to asbestos and that tumour markers cannot distinguish MPM. Definitive diagnosis required tissue biopsy showing invasion, with immunohistochemistry using at least two mesothelial and two (adeno)carcinoma markers. They advised staging with the TNM-based IMIG/UICC classification. An anti-folate/platinum doublet was the only approved first-line standard of care. There was no second-line standard, and patients were recommended to join trials. Radiotherapy could be considered for pain palliation, while prophylactic drain-tract irradiation was not proven useful. Surgery was indicated for effusion palliation, diagnosis and staging, multimodality treatment preferably within a study, and macroscopic complete resection.

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 is a clinical practice guideline, not a new study. Writing for the European Society for Medical Oncology Guidelines Committee, the authors gave recommendations on diagnosing, staging, treating and following up malignant pleural mesothelioma. They drew on literature they selected; many recommendations carry an evidence level and a grade, some only a grade, and ungraded statements were considered standard clinical practice. For diagnosis, they recommended an occupational history with emphasis on asbestos exposure, chest CT scanning, and efforts to obtain a tissue specimen in all patients with one-sided pleural thickening. They stated there is no place for screening people exposed to asbestos and that tumour markers cannot distinguish the disease. They wrote that definitive diagnosis requires recognising tissue invasion, and recommended immunohistochemistry for all primary diagnoses. They advised staging with the most recent IMIG/UICC system. They called an anti-folate plus platinum drug combination the only approved standard of care for inoperable mesothelioma. They stated that radiotherapy to prevent tumour growth in drainage tracts has not been proved useful, and listed indications for surgery. Trial results it describes come from other studies.

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 based on literature selected by the authors); not original research. Levels of evidence and grades of recommendation were applied to many statements, while statements without grading were considered justified standard clinical practice by the experts and the ESMO faculty
• Who was studied: No study population; the recommendations address the diagnosis, staging, treatment and follow-up of patients with malignant pleural mesothelioma (MPM)
• Exposure: Asbestos is discussed as background only. The guideline states that occupational asbestos exposure accounts for more than 80% of MPM cases. No fiber types are named and no exposure was studied.
• Main results:
  • Recommendation: diagnostic procedures should include an occupational history with emphasis on asbestos exposure (evidence level II, grade A)
  • Recommendation: diagnostic procedures should include CT scanning of the thorax (evidence level II, grade A)
  • Recommendation: in all patients with one-sided (unilateral) pleural thickening, with or without fluid and/or calcified asbestos plaques, efforts should be made to obtain a pathological specimen
  • Recommendation: there is no place for screening of persons exposed to asbestos (evidence level IV, grade B)
  • Recommendation: tumour markers cannot distinguish MPM (evidence level II, grade B)
  • Some recommendations carry a grade but no level of evidence; for example, confirmation by biopsy of frankly malignant effusion cytology is recommended with grade A and no level of evidence
  • Recommendation: recognition of tissue invasion is required for a definitive diagnosis of MPM
  • Recommendation: immunohistochemistry is recommended for all primary diagnoses of MPM (evidence level IV, grade A)
  • Recommendation: in the absence of a uniform, validated staging system, experts advocate the most recent TNM-based IMIG/UICC classification
  • Recommendation: for unresectable mesothelioma, an anti-folate plus platinum doublet is the only approved standard of care (evidence level I, grade A)
  • Recommendation: radiotherapy to prevent growth in drainage tracts is not proved to be useful (evidence level III, grade A)
  • Recommendation: indications for surgery include palliation of pleural effusions when chest tube drainage is not successful, among other listed indications
• The authors' conclusion: The article has no separate conclusion section; the authors' recommendations are collected in a summary table (Table 2)

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Incidence, Asbestos Exposure, Occupational History, Thorax, Pleural Thickening, Biopsy, Immunohistochemistry.

Related studies

• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up — S. Kusamura, V. Kepenekian, 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)
• Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) — A.J. Alberg, J.G. Ford, et al. (2007)

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