Clinical practice guidelines for the management of malignant pleural mesothelioma were released in May 2020 by the European
Respiratory Society, European Society of Thoracic Surgeons, European Association for Cardio-Thoracic Surgery, and European Society for Radiotherapy and Oncology.
Epidemiology Research Priorities
The task force recommends large international epidemiological studies to determine the relationship between pleural plaques and malignant pleural mesothelioma.
Additionally, well-designed clinical trials are needed to determine the effectiveness of CT screening in populations exposed to asbestos.
Further research is needed, and highly encouraged, on biomarkers for malignant pleural mesothelioma, as the ones proposed previously have not proven useful for diagnosis, prognosis, or clinical follow-up for disease monitoring.
Staging Research Priorities
The task force encourages increased prospective data collection regarding tumor thickness and volume measurements.
Additionally, it encourages the prospective use of volumetric assessment software for pretreatment staging investigations.
Other prognostic factors that are important are routine use of the Brims score, in combination with other scores, as part of clinical trials for prospective validation.
Surgery Recommendations & Research Priorities
The task force recommends thorascopic talc poudrage to control recurrent malignant pleural mesothelioma effusions as their first choice to achieve pleurodesis in patients with expanded lungs.
In symptomatic patients who are stable enough to undergo surgery but who will not benefit from chemical pleurodesis or an indwelling catheter, or in whom these have failed, the task force suggests palliative video-assisted thoracic surgery/partial pleurectomy to obtain pleural effusion control.
Malignant pleural mesothelioma patients who are being considered for radical surgery (eg, extrapleural pneumonectomy or pneumonectomy/decortication) should be included in national/international surgical registries or prospective randomized controlled clinical trials.
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