Malignant Pleural Mesothelioma

Last updated March 17, 2022

Key Points

Key Points

  • Mesothelioma should be reported as epithelial, sarcomatoid or biphasic, because these subtypes have a clear prognostic significance.
  • The optimal approach to mesothelioma measurement requires the expertise of a radiologist to identify measurement sites on CT as per modified RECIST for mesothelioma.
  • When offering maximal surgical cytoreduction, lung-sparing options (pleurectomy/decortication (P/D), extended P/D) should be the first choice, due to decreased operative and long-term risk. Extrapleural pneumonectomy (EPP) may be offered in highly selected patients when performed in centers of excellence.
  • Maximal surgical cytoreduction as a single modality treatment is generally insufficient; additional anti-neoplastic treatment (chemotherapy and/or radiation therapy) should be administered. It is recommended that this treatment decision should be made with multidisciplinary input.
  • Chemotherapy should be offered to patients with mesothelioma because it improves survival and quality of life.
  • The recommended first-line chemotherapy for patients with mesothelioma is pemetrexed plus platinum. Patients should also be offered the option of enrolling in a clinical trial.
  • The addition of bevacizumab to pemetrexed-based chemotherapy improves survival in select patients and therefore may be offered to patients with no contraindications to bevacizumab.
  • In patients who may not be able to tolerate cisplatin, carboplatin may be offered as a substitute for cisplatin.
  • Radiation therapy should be offered as an effective treatment modality to palliate patients with symptomatic disease.

Diagnosis

Diagno...

...cians should perform an initial thorac...


...atients for whom antineoplastic treatment is pla...


...performing a thoracoscopic biopsy, the minimal num...


...atients with suspected mesothelioma in who...


...nts who are not candidates for thoracosco...


...tologic evaluation of pleural fluid can be an ini...


...mination should be supplemented by immunohisto...


...thelioma should be reported as epit...


...urgical, thoracoscopic, or open pleural biopsi...


...non-tissue based biomarkers that are unde...


...based biomarkers that are under evaluation at thi...


...T scan of the chest and upper abdomen with...

...CT should usually be obtained for initial sta...

...abnormalities that suggest metastatic d...

...eferably with IV contrast) may be obtained to f...

...tients being considered for maximal surgical...

...the presence of contralateral pleur...

...ts with suspicious findings for intra-abdominal...

...e current AJCC/UICC staging classification rema...

...imal approach to mesothelioma measurement...

...nt of tumor volume by CT scan may...

...mended that tumor response classificatio...


Treatment

...Treatment...

...Chemotherapy...

...ould be offered to patients with me...

...patients with epithelial histology and minimal p...

...ted patients with a poor performance statu...

...recommended first-line chemotherapy for...

...e addition of bevacizumab to pemetrexed-based c...

...not recommended for patients with PS ≥2, sub...

...ients who may not be able to tolerate c...

...h pemetrexed-based chemotherapy may b...

...imited activity of 2nd line chemotherapy in patien...

...ts for whom clinical trials are not an option, v...

...c patients with epithelial mesothelioma an...

...ne pemetrexed-based chemotherapy should be given...

...nsufficient evidence to support th...


...Surgical Cytored...

...selected patients with early stage disea...

...urgical cytoreduction as a single modality...

...atients with transdiaphragmatic disease, mul...

...atients with histologically confirmed sarcomatoid...

...ipsilateral histologically-confirmed...

...ipsilateral histologically-confirmed mediast...

...l cytoreduction (either lung sparin...

...have a symptomatic pleural effusion, who ar...

...ho have a symptomatic pericardial effusi...

...ce surgical cytoreduction is not expected to yie...

...otherapy may be given pre- or post-operat...

...ant radiation therapy may be associated...

...n the context of multimodality treatment, four to...

...vitary therapies (chemotherapy or photodynam...

...eled pleural catheters are NOT recommended in pa...

...n patients who are not candidates for maxi...


...Radiation...

Prophylactic irradiation of intervention trac...

...ecommended that adjuvant radiation sho...

...py should be offered as an effective t...

...recommended that standard dosing regimens used in...

...ation therapy may be offered to pat...

...oracic adjuvant radiation therapy may be offe...

...cic neo-adjuvant radiation therapy may be off...

...adjuvant intensity-modulated radiation therapy...

...the potential for severe pulmonary toxicity, neo...

...lliative radiation therapy, electrons, 2D, 3D,...

...r adjuvant or neoadjuvant hemithoracic...

...is recommended that standard dosimetric guidelin...