Second Italian consensus conference on malignant pleural mesothelioma: state of the art and recommendations

Our plain-English summary of Second Italian consensus conference on malignant pleural mesothelioma: state of the art and recommendations, by C. Pinto, S. Novello, V. Torri, et al (Cancer Treatment Reviews, 2013).

The study

• Authors: C. Pinto, S. Novello, V. Torri, A. Ardizzoni, P.G. Betta, P.A. Bertazzi, G.A. Casalini, C. Fava, B. Fubini, C. Magnani, D. Mirabelli, M. Papotti, U. Ricardi, G. Rocco, U. Pastorino, G. Tassi, L. Trodella, M. Zompatori, G. Scagliotti
• Journal: Cancer Treatment Reviews
• Published: 2013;39(4):328-39
• Type of article: Consensus statement, Review
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a relevant public health issue. A large amount of data indicate a relationship between mesothelioma and asbestos exposure. MPM incidence has considerably and constantly increased over the past two decades in industrialized countries and is expected to peak in 2010-2020. In Italy, the standardized incidence rate in 2008 was 3.6 and 1.3 per 100,000 in men and women respectively, with wide differences from one region to another. The approach to this disease remains difficult and complex in terms of pathogenic mechanism, diagnosis, staging and treatment thus an optimal strategy has not yet been clearly defined. The Second Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Turin (Italy) on November 24-25, 2011: recommendations on MPM management for public health institutions, clinicians and patients are presented in this report.

Copyright © 2012 Elsevier Ltd. All rights reserved.

In plain English

This article reported the Second Italian Multidisciplinary Consensus Conference on malignant pleural mesothelioma, held in Turin in November 2011. It reported no new patient data. Expert panels reviewed published evidence and issued recommendations on epidemiology, pathology, imaging, chemotherapy, surgery and radiotherapy. Citing the Italian mesothelioma registry (ReNaM), the report gave a 2008 incidence of 3.6 per 100,000 in men and 1.3 in women. Asbestos exposure was detected in 80.5% of registry cases that had an exposure assessment, and non-occupational exposure was estimated to cause 8.3% of cases in Italy. The report stated that all asbestos types cause mesothelioma and that amphiboles are more potent than chrysotile, by a margin still debated. Recommendations included always suspecting asbestos exposure, thoracoscopy with at least five biopsies whenever possible, and cisplatin with pemetrexed as standard first-line chemotherapy for suitable patients. The authors noted that cumulative dose is hard to estimate and that one panel member did not fully endorse some exposure statements. They recommended health surveillance to support formerly exposed people, while noting no data exist on any screening benefit for disease occurrence or prognosis.

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 conference report with recommendations, based on expert panels' review of published evidence (GRADE approach for treatment-efficacy questions)
• Who was studied: No patient population of its own. Panels of Italian experts reviewed the literature on malignant pleural mesothelioma at a conference in Turin, Italy, in November 2011.
• Exposure: Asbestos in general. The report states that all asbestos types cause mesothelioma and that amphiboles are more potent than chrysotile. Asbestiform minerals, man-made mineral fibers, ionizing radiation and other possible causes are also discussed.
• Main results:
  • Citing the Italian registry (ReNaM), the standardized incidence rate of malignant pleural mesothelioma in Italy in 2008 was 3.6 per 100,000 in men and 1.3 per 100,000 in women.
  • Citing ReNaM, rates for peritoneal mesothelioma were 0.24 (men) and 0.12 (women), and 1422 incident cases of mesothelioma (all sites) were observed.
  • In the ReNaM case series, asbestos exposure was detected in 80.5% of cases with an exposure assessment.
  • Non-occupational exposure was estimated (from a cited study) to cause 8.3% of malignant pleural mesothelioma in Italy.
  • In Italy, median survival of malignant pleural mesothelioma cases diagnosed in 1990 to 2001 was 9.8 months, and less than 10% were alive after 3 years.
  • The group's own systematic review of the literature found that mesothelioma risk increased with cumulative dose.
  • The epidemiology panel recommended that asbestos exposure always be suspected, with non-occupational exposure investigated too.
  • The epidemiology panel recommended health surveillance by qualified, experienced health services as a form of support for formerly exposed people.
  • The pathology panel recommended thoracoscopy as the best biopsy technique, with a minimum of five biopsies whenever possible.
  • The imaging panel stated that a chest X-ray finding of pleural plaques alone does not require further investigation.
  • The panel unanimously considered cisplatin plus pemetrexed the gold standard first-line therapy for young patients with good performance status and no other illnesses.
• The authors' conclusion: The authors presented recommendations on managing malignant pleural mesothelioma for public health institutions, clinicians and patients.
• Limitations the authors state:
  • The group acknowledged difficulties and possible errors in estimating cumulative asbestos dose.
  • One panel member did not fully endorse some of the statements on asbestos exposure and mesothelioma occurrence.
  • No data exist on any benefit of screening formerly exposed people in terms of disease occurrence or prognosis, although health surveillance is still recommended as support.
  • Evidence on the precise role of radiotherapy is limited.

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, State-of-the-Art Defense, Mesothelioma, Asbestos Exposure, Incidence, Staging.

Related studies

• The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations — S. Novello, C. Pinto, et al. (2016)
• Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma — C. Pinto, A. Ardizzoni, et al. (2011)
• Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group — D. Rice, V. Rusch, et al. (2011)
• Consensus Report of the 2015 Weinman International Conference on Mesothelioma — M. Carbone, S. Kanodia, et al. (2016)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)
• Cancer risk after cessation of asbestos exposure: a cohort study of Italian asbestos cement workers — C. Magnani, D. Ferrante, et al. (2008)

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