Malignant Pleural Mesothelioma

Publication Date: January 18, 2018

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

...agnosis

...icians should perform an initial thora...


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


...rming a thoracoscopic biopsy, the minimal nu...


In patients with suspected mesothelio...


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


...evaluation of pleural fluid can be an initial scr...


...mination should be supplemented by...


...uld be reported as epithelial, sarcomatoi...


...rgical, thoracoscopic, or open pleural biopsies...


...n-tissue based biomarkers that are under evalua...


...le tumor genomic sequencing is currently done...


Stagin...

...chest and upper abdomen with IV con...

.../CT should usually be obtained for initial st...

...rmalities that suggest metastatic dise...

...(preferably with IV contrast) may be obtaine...

For patients being considered for maximal...

...nce of contralateral pleural abnorm...

...tients with suspicious findings for intra-abdo...

...current AJCC/UICC staging classifi...

...ptimal approach to mesothelioma meas...

Assessment of tumor volume by CT scan may enhance...

...ended that tumor response classification...


Treatment

...eatment

...otherapy...

...rapy should be offered to patients with me...

In asymptomatic patients with epithelial his...

...patients with a poor performance status...

...mended first-line chemotherapy for patien...

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

...cizumab is not recommended for patients with PS ...

...may not be able to tolerate cispl...

...nt with pemetrexed-based chemotherapy may b...

...imited activity of 2nd line chemot...

In patients for whom clinical trials a...

...ic patients with epithelial mesothelioma and a lo...

...tline pemetrexed-based chemotherapy should be...

...is insufficient evidence to support t...


...al Cytoreduction

...patients with early stage disease, i...

...l surgical cytoreduction as a singl...

...ransdiaphragmatic disease, multifocal ch...

...histologically confirmed sarcomatoid meso...

...tients with ipsilateral histologically-conf...

A maximal cytoreduction (either lu...

...ients who have a symptomatic pleural...

...who have a symptomatic pericardial effusio...

...nce surgical cytoreduction is not expected t...

...therapy may be given pre- or post-oper...

...iation therapy may be associated with a decreased...

...ntext of multimodality treatment,...

...tary therapies (chemotherapy or photodynami...

...pleural catheters are NOT recommended in...

...ients who are not candidates for m...


...adiation Thera...

...actic irradiation of intervention t...

...commended that adjuvant radiation shoul...

...n therapy should be offered as an effecti...

...ended that standard dosing regimens...

...therapy may be offered to patients with localize...

...acic adjuvant radiation therapy ma...

...ic neo-adjuvant radiation therapy may be o...

...juvant intensity-modulated radiation therapy m...

...tential for severe pulmonary toxicity, neoadj...

...tive radiation therapy, electrons, 2D, 3D, and...

...r adjuvant or neoadjuvant hemithoracic...

...d that standard dosimetric guidelines for organs...