GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

Our plain-English summary of GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma, by J. Luna, A. Bobo, J.J. Cabrera-Rodriguez, et al (World Journal of Clinical Oncology, 2021).

The study

• Authors: J. Luna, A. Bobo, J.J. Cabrera-Rodriguez, M. Pagola, M. Martín-Martín, M.Á.G. Ruiz, M. Montijano, A. Rodríguez, L. Pelari-Mici, A. Corbacho, M. Moreno, F. Couñago
• Journal: World Journal of Clinical Oncology
• Published: 2021;12(8):581-608
• Type of article: Review
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumor with poor prognosis and rising incidence. Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement. Numerous therapeutic advances have been made in recent years, including the use of less aggressive surgical techniques associated with lower morbidity and mortality (e.g., pleurectomy/decortication), technological advancements in the field of radiotherapy (intensity-modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy, proton therapy), and developments in systemic therapies (chemotherapy and immunotherapy). These improvements have had as yet only a modest effect on local control and survival. Advances in the management of MPM and standardization of care are hampered by the evidence to date, limited by high heterogeneity among studies and small sample sizes. In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology, we review clinical, histologic, and therapeutic aspects of MPM, with a particular focus on all aspects relating to radiotherapy, including the current evidence base, associations with chemotherapy and surgery, treatment volumes and planning, technological advances, and reradiation.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This was a review and clinical guideline by the Oncological Group for the Study of Lung Cancer of the Spanish Society of Radiation Oncology. It reported no new patient study, but an appendix described one illustrative patient case. The authors reviewed published research and guidelines on malignant pleural mesothelioma, with a focus on radiotherapy. The guideline stated that asbestos is the main cause of the disease. The authors recommended 50 to 54 Gy in daily fractions of 1.8 to 2 Gy, with a boost to at least 60 Gy for residual disease. They said dose limits for nearby organs must always be met, and that palliative treatments normally use lower doses. They stated that hemithoracic radiotherapy remains the recommended standard of care after extrapleural pneumonectomy for operable stage I to III disease. They wrote that intensity-modulated radiotherapy can be considered after pleurectomy/decortication in well-selected patients, that radiotherapy can be considered for pain from tumor growth, and that prophylactic radiotherapy is not recommended. The authors concluded that advances have brought modest improvements in survival and local control. They called for adequately powered, homogeneous studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review and clinical practice guideline: a narrative review of published studies and existing guidelines, with recommendations graded using the European Society of Medical Oncology system. It includes one illustrative clinical case in an appendix.
• Who was studied: No new patient group was studied. The authors reviewed published studies and guidelines on patients with malignant pleural mesothelioma. An appendix describes one illustrative clinical case: a 62-year-old man with 25 years of occupational asbestos exposure, treated with chemotherapy, lung-sparing surgery and adjuvant radiotherapy.
• Exposure: This was not an exposure study. The topic was radiotherapy as treatment for malignant pleural mesothelioma. As background, the guideline stated that asbestos is the main cause of the disease. No asbestos fiber types were specified. Other minerals mentioned were erionite and fluoro-edenite.
• Main results:
  • The guideline recommended a radiation dose of 50 to 54 Gy in daily fractions of 1.8 to 2 Gy. Patients with residual disease need a boost to at least 60 Gy, and dose constraints for organs at risk must be met at all times.
  • For treatments with palliative intent, doses are normally low: 20 Gy in five fractions or 30 Gy in 10 fractions.
  • The authors stated that hemithoracic radiotherapy remains the recommended standard of care after extrapleural pneumonectomy (EPP) for patients with operable stage I to III malignant pleural mesothelioma.
  • The authors stated that intensity-modulated radiotherapy (IMRT) can be considered as adjuvant therapy after pleurectomy/decortication (P/D) in well-selected patients.
  • Radiotherapy can be considered to relieve pain related to tumor growth (graded II, A).
  • Prophylactic radiotherapy was not recommended in clinical practice.
  • Proton therapy can be considered for selected patients at experienced centers, preferably within a clinical trial.
• The authors' conclusion: The authors concluded that advances in surgery, radiotherapy and systemic therapies have brought modest improvements in survival and local control, with considerably lower toxicity than classic treatments. They said adequately powered, homogeneous clinical studies are needed.
• Limitations the authors state:
  • The authors stated that the available evidence is limited by high heterogeneity among studies and small sample sizes.
  • The authors noted a lack of phase III randomized controlled trials.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Palliative Care, Metastasis, Pleurectomy/Decortication (P/D), Intensity-Modulated Radiation Therapy (IMRT), Proton Therapy, Chemotherapy.

Related studies

• Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) — A.J. Alberg, J.G. Ford, et al. (2007)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — P. Baas, D. Fennell, et al. (2015)
• Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up — S. Kusamura, V. Kepenekian, et al. (2021)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Clinical practice guidelines for the diagnosis and surveillance of BAP1 tumour predisposition syndrome — F. Lalloo, A. Kulkarni, et al. (2023)
• Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lung cancer and mesothelioma — R. Govindan, C. Aggarwal, et al. (2022)

Browse return to medical research.