Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting

Our plain-English summary of Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting, by R.R. Gill, A.S. Tsao, H.L. Kindler, et al (Journal of Thoracic Oncology, 2019).

The study

• Authors: R.R. Gill, A.S. Tsao, H.L. Kindler, W.G. Richards, S.G. Armato, R.J. Francis, D.R. Gomez, S. Dahlberg, A. Rimner, C.B. Simone, M. de Perrot, G. Blumenthal, A.A. Adjei, R. Bueno, D.H. Harpole, M. Hesdorffer, F.R. Hirsch, H.I. Pass, E. Yorke, K. Rosenzweig, B. Burt, D.A. Fennell, W. Lindwasser, S. Malik, T. Peikert, A.S. Mansfield, R. Salgia, H. Yang, V.W. Rusch, A.K. Nowak
• Journal: Journal of Thoracic Oncology
• Published: 2019;14(10):1718-1731
• Type of article: Consensus statement
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Detailed guidelines pertaining to radiological assessment of malignant pleural mesothelioma are currently lacking due to the rarity of the disease, complex morphology, propensity to invade multiple planes simultaneously, and lack of specific recommendations within the radiology community about assessment, reporting, and follow-up. In March 2017, a multidisciplinary meeting of mesothelioma experts was co-sponsored by the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and the Mesothelioma Applied Research Foundation. One of the outcomes of this conference was the foundation of detailed, multidisciplinary consensus imaging and management guidelines. Here, we present the recommendations for radiologic assessment of malignant pleural mesothelioma in the setting of clinical trial enrollment. We discuss optimization of imaging parameters across modalities, standardized reporting, and response assessment within clinical trials.

Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

In plain English

This article was a consensus statement, not a study of patients. It set out recommendations from a March 2017 meeting of mesothelioma experts convened by the National Cancer Institute (NCI) Thoracic Malignancy Steering Committee, the International Association for the Study of Lung Cancer and the Mesothelioma Applied Research Foundation. The recommendations covered imaging of malignant pleural mesothelioma in future NCI-sponsored clinical trials. The article did not address asbestos exposure. The authors recommended standardized imaging protocols across centers so data could be pooled, structured reports, and CT with contrast and 1-mm images. They also recommended adding MRI with contrast and diffusion-weighted imaging if available. For repeated FDG PET/CT scans, they recommended the same scanner and settings, with any history of pleurodesis recorded. They recommended mRECIST or mRECIST 1.1 to judge response, central reads where response rate or progression-free survival are key endpoints, and collecting stage information. They did not recommend tumor volume measurement for trials except as a research tool. The authors noted that quantitative staging measures are not validated and that PET/CT response evidence in mesothelioma comes from single-center studies. They concluded that internationally standardized imaging protocols are highly recommended.

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: Consensus statement (expert guideline) from a clinical trials planning meeting; not an original study
• Who was studied: No patient population was studied. The statement came from a meeting of mesothelioma experts convened in March 2017 by the NCI Thoracic Malignancy Steering Committee, IASLC and the Mesothelioma Applied Research Foundation.
• Exposure: The article does not address asbestos or any other exposure. Its subject is imaging methods (CT, MRI, FDG PET/CT) for malignant pleural mesothelioma in clinical trials.
• Main results:
  • Recommendation: standardize imaging protocols across expert centers so data can be pooled for future research.
  • Recommendation: the initial assessment should record tumor extent and clinical stage in a structured report.
  • Recommendation: CT with contrast optimized to show the tumor, using 1-mm axial images.
  • Recommendation: add MRI with contrast and diffusion-weighted imaging (DWI) if available.
  • Recommendation: repeated FDG PET/CT scans for response evaluation should use a harmonized protocol on the same scanner with the same settings.
  • Recommendation: a history of pleurodesis must be known in order to interpret FDG PET scans in mesothelioma patients.
  • Recommendation: use mRECIST or mRECIST 1.1 to assess response in clinical trials.
  • Recommendation: archive images and use central reads in trials where response rate or progression-free survival (PFS) are important endpoints.
  • Recommendation: collect information on stage.
  • Tumor volume measurement (volumetrics) is not currently recommended for clinical trials except as a research tool.
• The authors' conclusion: The authors concluded that internationally standardized imaging protocols are highly recommended to support clinical trial enrollment, interpretation and further research.
• Limitations the authors state:
  • Potential quantitative staging measures are not validated, so they are not required in clinical trials.
  • Evidence that FDG PET/CT is useful for response evaluation in mesothelioma comes only from single-center studies.
  • The image-acquisition parameters given are those used at some centers, and MRI parameters are expected to change as technology changes.

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, Clinical Trial, Lung Cancer, Mesothelioma.

Related studies

• Current and Future Management of Malignant Mesothelioma: A Consensus Report from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — A.S. Tsao, O.W. Lindwasser, et al. (2018)
• 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)
• Pathologic Considerations and Standardization in Mesothelioma Clinical Trials — M.S. Tsao, M. Carbone, et al. (2019)
• A Proposed System Toward Standardizing Surgical-Based Treatments for Malignant Pleural Mesothelioma, From the Joint National Cancer Institute-International Association for the Study of Lung Cancer-Mesothelioma Applied Research Foundation Taskforce — J.S. Friedberg, M.J. Culligan, et al. (2019)
• Imaging in pleural mesothelioma: a review of imaging research presented at the 9th International Meeting of the International Mesothelioma Interest Group — A.K. Nowak, S.G. Armato, et al. (2010)
• Imaging in pleural mesothelioma: a review of the 11th International Conference of the International Mesothelioma Interest Group — S.G. Armato, Z.E. Labby, et al. (2013)

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