Abstract

Malignant pleural mesothelioma (MPM) is a rare tumour but with increasing incidence and a poor prognosis. In 2008, the ERS/ESTS Taskforce brought together experts to propose practical and up-to-dated guidelines on management of MPM. Diagnosis: to obtain an earlier and reliable diagnosis of MPM, the experts recommend performing thoracoscopy except in case of preoperative contraindication or pleural symphysis. Pathology: standard staining procedures are insufficient in about 10% of cases. Therefore we propose using specific immunohistochemistry markers on pleural biopsies. Staging: in the absence of a uniform, robust and validated staging system, we advice to use of the most recent TNM based classification, and we propose a three steps pre-treatment assessment. Monitoring: Patient"s performance status and histological subtype are currently the only prognostic factors of clinical importance in management of MPM. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: MPM exhibits a high resistance to chemotherapy and only few patients are candidate for radical surgery. New therapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach should be included in a prospective trial in specialized centres.