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Best Practices for Pleural Mesothelioma: Updated Recommendations from Europe’s Top Doctors

Best Practices for pleural mesothelioma

Europe’s top mesothelioma experts have released new best practices for pleural mesothelioma. They include the latest recommendations on diagnosis, staging, monitoring, and treatment.

The task force was made up of members from: 

  • European Respiratory Society (ERS)
  • European Society of Thoracic Surgeons (ESTS)
  • European Association for Cardio-Thoracic Surgery (EACTS)
  • European Society for Radiotherapy and Oncology (ESTRO)

This is the first time the best practices for pleural mesothelioma were updated since 2009. The group based the new recommendations on mesothelioma data gathered in the last decade. 

Mesothelioma Remains a Global Challenge

Malignant mesothelioma is one of the world’s most challenging cancers. Doctors know that asbestos exposure causes mesothelioma. But many other things about this disease are a mystery. 

Some people with a history of asbestos exposure get pleural mesothelioma while others do not. The symptoms of mesothelioma are similar to other conditions, making diagnosis difficult. Many doctors have never seen a single case.

These challenges make it crucial to have best practices for pleural mesothelioma. Mesothelioma rarely responds to standard cancer treatments. Best practices give doctors a starting point to help patients. 

Developing New Best Practices for Mesothelioma

The last set of European mesothelioma guidelines came out in 2009. To create the new guidelines, the group reviewed mesothelioma studies from 2009 to 2018. They grouped the findings into four categories.

Diagnosis: They say that biopsies are still the among the best practices for pleural mesothelioma diagnosis. Tissue can be gathered either by thoracoscopy or through an image-guided needle biopsy. 

Pathology: Standard pathology staining techniques do not work in about 10 percent of mesothelioma cases. The authors recommend testing for mesothelioma biomarkers like BAP-1 and CDKN2A, too.

Prognosis: Mesothelioma subtype, overall health, and tumor volume are the main ways to determine how a patient will respond to treatment. The group says doctors should record other potential factors for use in future clinical trials.

Treatment: Chemotherapy and clinical trials are the best practices for pleural mesothelioma treatment.  The group says clinical trials let patients safely access combination treatments

“Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres,” they conclude.


Opitz, I, et al, “ERS/ESTS/EACTS/ESTRO Guidelines for the Management of Malignant Pleural Mesothelioma”, May 25, 2020, European Journal of Cardiothoracic Surgery, Epub ahead of print, https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezaa158/5843681?redirectedFrom=fulltext

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