ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma.

摘要: The European Respiratory Society (ERS)/European of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after systematic review the 2009-2018 literature. evidence was appraised using Grading Recommendations, Assessment, Development Evaluation approach. syntheses were discussed recommendations formulated by this multidisciplinary group experts. Diagnosis: biopsies remain gold standard confirm diagnosis, usually obtained thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases symphysis or performance status. Pathology: staining procedures are insufficient ∼10% cases, justifying use specific markers, including BAP-1 CDKN2A (p16) separation atypical mesothelial proliferation from MPM. Staging: absence uniform, robust validated staging system, we advise most recent 2016 8th TNM (tumour, node, metastasis) classification, an algorithm pre-therapeutic assessment. Monitoring: patient's status, histological subtype tumour volume main prognostic factors clinical importance routine MPM management. Other potential parameters should be recorded at baseline reported trials. Treatment: (chemo)therapy has limited efficacy patients only selected candidates radical surgery. New promising targeted therapies, immunotherapies strategies have been reviewed. Because data best combination treatment, emphasise that who considered multimodal approach, surgery, treated as part trials MPM-dedicated centres.