GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

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.

Keywords: Malignant pleural mesothelioma, Chemotherapy, Surgery, Radiotherapy, Radiation techniques, Reradiation

Core Tip: Malignant pleural mesothelioma is a rare tumor that is very challenging to treat. Technological advances in surgery and radiotherapy are largely responsible for the marginally improved outcomes observed in recent years. Heterogeneity among studies and a lack of phase III randomized controlled trials are some of the main barriers to achieving more effective, standardized treatments. In this review article, we provide an in-depth analysis of changes in the clinical, histologic, and therapeutic profile of malignant pleural mesothelioma in recent decades and highlight the main research areas in this field.