iv73.full - clinical recommendations Annals of Oncology 20...

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Annals of Oncology 20 (Supplement 4): iv73–iv75, 2009 doi:10.1093/annonc/mdp134 clinical recommendations Malignant pleural mesothelioma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up R. A. Stahel 1 , W. Weder 2 3 On behalf of the ESMO Guidelines Working Group* 1 Clinic and Policlinic of Oncology; 2 Department of Thoracic Surgery, University Hospital of Zu ¨rich, Zu ¨rich, Switzerland; 3 Medical Oncology Service, Vall d’Hebron University Hospital, Barcelona, Spain incidence Malignant pleural mesothelioma (MPM) is a rare tumor. The incidence is 1.25/100 000 in Great Britain and 1.1/100 000 in Germany. Within the next 20 years the incidence is estimated to double in many countries. Exposure to asbestos is a well- established etiological factor for MPM, with occupational exposure having been documented in 70%–80% of those affected. diagnosis Patients typically present with shortness of breath due to pleural effusion or chest pain in a more advanced stage. The diagnosis is usually suggested by imaging studies (unilateral pleural thickening; pleural effusion). An occupational history must be obtained. Cytological examination of the effusion can be diagnostic, but often shows equivocal results. Therefore, histology, including immunohistochemistry, is the gold standard. Video- assisted thoracoscopy or open pleural biopsy in a fused pleural space may be necessary to provide sufficient material for accurate histological diagnosis. There are three main histological types (epithelial, sarcomatous and mixed), with ± 60% being epithelial. Recent data suggest the possible contribution of serum mesothelin-related proteins and osteopontin as useful markers to support the diagnosis of mesothelioma; however, the precise role of these markers is yet to be defined. staging and risk assessment Clinical staging is based on a thoracic CT scan; however, the translation of the images into TNM (tumor–node–metastasis) stages is often not conclusive. Mediastinoscopy and video- assisted thoracoscopy may be useful in determining the stage. Accurate initial staging is essential to provide both prognostic information and guidance on the most appropriate therapeutic options. Several different staging systems exist; among them is the international staging system for MPM, which emphasizes the extent of disease after surgery in a traditional TNM system and stratifies patients into similar prognostic categories (Table 1). The Cancer and Leukemia Group B and the European
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This note was uploaded on 05/24/2010 for the course MED 122 taught by Professor Tera during the Winter '08 term at Anadolu University.

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iv73.full - clinical recommendations Annals of Oncology 20...

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