Introduction
The purpose of this guideline is to provide recommendations for the management of patients with malignant pleural mesothelioma (MPM), an aggressive tumor with a poor prognosis. In the United States, about 3,000 new cases are diagnosed each year. The median overall survival of patients with advanced surgically unresectable disease is about 12 months. Given the rarity of this malignancy, there have been few large randomized trials, especially for surgical management of this disease. In general, a minority of patients are candidates for surgical resection at time of presentation; thus, the mainstay of treatment is systemic chemotherapy. For patients who are surgical candidates, surgery is performed as part of multimodality therapy involving chemotherapy with or without radiation therapy. The aim of this clinical practice guideline is to outline the management of patients with MPM, including diagnosis, pathologic confirmation, and surgical and medical management.
Guideline Questions
This clinical practice guideline addresses five overarching clinical questions: (1) What is the optimal approach to obtain an accurate diagnosis of mesothelioma? (2) What initial assessment is recommended before initiating any therapy for mesothelioma? (3) What is the appropriate first- and second-line systemic treatment of patients with mesothelioma? (4) What is the appropriate role of surgical cytoreduction in the management of mesothelioma? (5) When should radiation be recommended for mesothelioma?
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