Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up

Our plain-English summary of Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up, by S. Kusamura, V. Kepenekian, L. Villeneuve, et al (European Journal of Surgical Oncology, 2021).

The study

• Authors: S. Kusamura, V. Kepenekian, L. Villeneuve, R.J. Lurvink, K. Govaerts, I.H.J.T. De Hingh, B.J. Moran, K. Van der Speeten, M. Deraco, O. Glehen, PSOGI
• Journal: European Journal of Surgical Oncology
• Published: 2021;47(1):36-59
• Type of article: Guideline
• Cited by: 103 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a set of clinical practice guidelines, not a new study of patients. A Peritoneal Surface Oncology Group International (PSOGI) steering committee summarized published research and selected 39 expert panellists, who voted over three Delphi rounds on 42 questions about peritoneal mesothelioma. Evidence and recommendations were graded with the GRADE system. The guidelines covered diffuse malignant peritoneal mesothelioma (DMPM) and two less aggressive forms, multicystic and well-differentiated papillary peritoneal mesothelioma. On asbestos, the panel stated, on very low evidence and with agreement from 10 of 27 voters (37%), that people with any current or past asbestos exposure could be advised to have a yearly abdominal ultrasound to detect DMPM early. Other recommendations included diagnosis from tissue samples rather than fluid cytology (27/27). Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS-HIPEC) was recommended for fit patients with resectable DMPM at specialized centers (26/27). Cisplatin with pemetrexed was the preferred chemotherapy for patients who could not have surgery (25/27). The authors noted that the CRS-HIPEC data were uncontrolled and retrospective. They concluded that the guidelines could be considered consensus guidelines and that patients should be referred promptly to specialized centers.

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 guidelines developed by expert consensus: literature summary by a steering committee, three-round Delphi vote on 42 questions, recommendations rated with the GRADE system
• Who was studied: 39 selected expert panellists, mainly surgeons treating peritoneal malignancies plus medical oncologists and pathologists; most votes were reported out of 27 (some out of 19). The guidelines concern patients with diffuse malignant, multicystic, and well-differentiated papillary peritoneal mesothelioma. Results were presented at the PSOGI 2018 meeting in Paris.
• Exposure: Not an exposure study. Asbestos was addressed only in a screening recommendation for people with any current or past asbestos exposure.
• Main results:
  • Screening recommendation: people with any history of asbestos exposure could be advised to have a yearly abdominal ultrasound for early detection of DMPM. Level of evidence D (very low), weak positive recommendation (II), consensus 10/27 (37%).
  • For pathological diagnosis, adequate tissue from core needle biopsy or explorative laparoscopy was judged mandatory rather than cytology of effusion fluid. Level A, strength I, consensus 27/27 (100%).
  • CRS-HIPEC was recommended in DMPM patients rather than palliative systemic chemotherapy, provided the patient is fit for major surgery, the disease is resectable, and treatment is done in a specialized center. Level B, strength I, consensus 26/27 (96.3%).
  • Four factors were judged absolute contraindications to CRS-HIPEC in DMPM: sarcomatoid histology, massive small bowel serosa involvement, concomitant pleural disease, and retroperitoneal and/or cardiophrenic lymph node involvement.
  • For non-operable or non-resectable DMPM, platinum-based systemic chemotherapy was proposed, with cisplatin plus pemetrexed as first choice and cisplatin plus gemcitabine as second. Level B, strength I, consensus 25/27 (92.6%).
  • Cisplatin and doxorubicin was judged the best HIPEC drug regimen in DMPM. Level C, strength I, consensus 23/27 (85.2%).
  • Follow-up extended to 7 years after CRS-HIPEC could be considered in DMPM. Level B, strength II, consensus 18/27 (66.7%).
  • For multicystic peritoneal mesothelioma, systemic chemotherapy was judged not indicated. Level C, strong negative (IV), consensus 17/27 (63%).
• The authors' conclusion: The authors concluded that these could be considered consensus guidelines for managing DMPM, and that patients should be referred promptly to specialized peritoneal surface malignancy centers for workup and treatment planning.
• Limitations the authors state:
  • The authors stated that the data on CRS-HIPEC outcomes in DMPM are uncontrolled and retrospective.
  • The authors stated that the asbestos screening recommendation rests on a very low level of evidence.
  • The authors stated that retrospective studies of repeat CRS-HIPEC cannot separate selection bias from a true treatment effect.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma.

Related studies

• The Delphi and GRADE methodology used in the PSOGI 2018 consensus statement on Pseudomyxoma Peritonei and Peritoneal Mesothelioma — R.J. Lurvink, L. Villeneuve, et al. (2021)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — P. Baas, D. Fennell, et al. (2015)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Indications for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: a clinical practice guideline — R.C. Auer, D. Sivajohanathan, et al. (2020)
• Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the Peritoneal Surface Oncology Group International (PSOGI) — D. Goéré, G. Passot, et al. (2017)

Browse more research in European Journal of Surgical Oncology, or return to medical research.