ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma
- PMID: 32448904
- DOI: 10.1093/ejcts/ezaa158
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
Keywords: Chemotherapy; Guidelines; MPM; Multimodality; Radiotherapy; Surgery.
© The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. All rights reserved in respect of European Journal of Cardio-Thoracic Surgery, © European Association for Cardio-Thoracic Surgery 2020 and European Respiratory Journal, © European Respiratory Society 2020. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.
Comment in
-
Divided by an ocean of water but united in an ocean of uncertainty: a transatlantic review of mesothelioma surgery guidelines.Eur J Cardiothorac Surg. 2021 Jan 4;59(1):8-11. doi: 10.1093/ejcts/ezaa363. Eur J Cardiothorac Surg. 2021. PMID: 33395697 No abstract available.
Similar articles
-
ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma.Eur Respir J. 2020 Jun 11;55(6):1900953. doi: 10.1183/13993003.00953-2019. Print 2020 Jun. Eur Respir J. 2020. PMID: 32451346
-
Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma.Eur Respir J. 2010 Mar;35(3):479-95. doi: 10.1183/09031936.00063109. Epub 2009 Aug 28. Eur Respir J. 2010. PMID: 19717482
-
The 2019 ERS/ESTS/EACTS/ESTRO Guidelines on the Management of Patients With Malignant Pleural Mesothelioma.J Cardiothorac Vasc Anesth. 2021 Feb;35(2):378-388. doi: 10.1053/j.jvca.2020.07.017. Epub 2020 Jul 30. J Cardiothorac Vasc Anesth. 2021. PMID: 32798169
-
European guidelines for the management of malignant pleural mesothelioma.Pol Arch Med Wewn. 2010 Dec;120(12):503-10. Pol Arch Med Wewn. 2010. PMID: 21178907 Review.
-
Treatment of malignant pleural mesothelioma: current status and future directions.Monaldi Arch Chest Dis. 2010 Jun;73(2):79-85. doi: 10.4081/monaldi.2010.302. Monaldi Arch Chest Dis. 2010. PMID: 20949774 Review.
Cited by
-
Incidence and Risk Factors of Chest Wall Metastasis at Biopsy Sites in Patients with Malignant Pleural Mesothelioma.Cancers (Basel). 2022 Sep 7;14(18):4356. doi: 10.3390/cancers14184356. Cancers (Basel). 2022. PMID: 36139517 Free PMC article.
-
GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma.World J Clin Oncol. 2021 Aug 24;12(8):581-608. doi: 10.5306/wjco.v12.i8.581. World J Clin Oncol. 2021. PMID: 34513595 Free PMC article. Review.
-
Landmark Trials in the Surgical Management of Mesothelioma.Ann Surg Oncol. 2021 Apr;28(4):2037-2047. doi: 10.1245/s10434-021-09589-5. Epub 2021 Jan 31. Ann Surg Oncol. 2021. PMID: 33521898 Review.
-
Integrative eQTL and Mendelian randomization analysis reveals key genetic markers in mesothelioma.Respir Res. 2025 Apr 13;26(1):140. doi: 10.1186/s12931-025-03219-4. Respir Res. 2025. PMID: 40223054 Free PMC article.
-
Impact of Neoadjuvant and Adjuvant Pleural Intensity-Modulated Radiotherapy in Multimodality Treatment for Malignant Pleural Mesothelioma.Thorac Cancer. 2025 Mar;16(5):e70024. doi: 10.1111/1759-7714.70024. Thorac Cancer. 2025. PMID: 40066644 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous