GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

Table 1 Infectious Diseases Society of America levels of evidence and grades of recommendation and European Society of Medical Oncology adaptation

IDSA United States Public Health Service Grading System for Ranking Recommendations in Clinical Guidelines		ESMO adaptation of IDSA Grading System
Category, grade	Definition	Category, grade	Definition
Strength of recommendation		Grades of recommendation
A	Good evidence to support recommendation for use	A	Strong evidence for efficacy with a substantial clinical benefit, strongly recommended, strongly recommended
B	Moderate evidence to support recommendation for use	B	Strong or moderate evidence for efficacy but with a limited clinical benefit, generally recommended
C	Poor evidence to support a recommendation	C	Insufficient evidence for efficacy or benefit does not outweigh the risk or the disadvantages (adverse events, costs, etc.), optional
D	Moderate evidence to support a recommendation against use	D	Moderate evidence against efficacy or for adverse outcome, generally not recommended
E	Good evidence to support a recommendation against use	E	Strong evidence against efficacy or for adverse outcome, never recommended
Quality of evidence		Levels of evidence
I	Evidence from > 1 properly randomized, controlled trial	I	Evidence from at least one large randomized, controlled trial of good methodological quality (low potential for bias) or meta-analyses of well-conducted randomized trials without heterogeneity
II	Evidence from > 1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from > 1 center); from multiple time series; or from dramatic results from uncontrolled experiments	II	Small randomized trials or large randomized trials with a suspicion of bias (lower methodological quality) or meta-analyses of such trials or of trials with demonstrated heterogeneity
III	Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees	III	Prospective cohort studies
		IV	Retrospective cohort studies or case-control studies
		V	Studies without control group, case reports, experts opinions

ESMO: European society for medical oncology; IDSA: Infectious Diseases Society of America.