{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:15:33Z","timestamp":1780514133664,"version":"3.54.1"},"reference-count":332,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"European Respiratory Society, European Society of Thoracic Surgeons"},{"DOI":"10.13039\/501100022438","name":"European Association for Cardio-Thoracic Surgery","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022438","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100011010","name":"European Society for Radiotherapy and Oncology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011010","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The European Respiratory Society (ERS)\/European Society of Thoracic Surgeons (ESTS)\/European Association for Cardio-Thoracic Surgery (EACTS)\/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS\/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009\u20132018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in \u223c10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient\u2019s performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies 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, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.<\/jats:p>","DOI":"10.1093\/ejcts\/ezaa158","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T15:21:59Z","timestamp":1589556119000},"page":"1-24","source":"Crossref","is-referenced-by-count":71,"title":["ERS\/ESTS\/EACTS\/ESTRO guidelines for the management of malignant pleural mesothelioma"],"prefix":"10.1093","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5900-9040","authenticated-orcid":false,"given":"Isabelle","family":"Opitz","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Scherpereel","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Thoracic Oncology, French National Network of Clinical Expert Centers for Malignant Pleural Mesothelioma Management (Mesoclin) , Lille,","place":["France"]},{"name":"Department of Pulmonary and Thoracic Oncology, University\u00a0Lille, CHU Lille , INSERM U1189, OncoThAI, Lille,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Berghmans","sequence":"additional","affiliation":[{"name":"Thoracic Oncology Clinic, Institut Jules Bordet , Brussels,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Psallidas","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust , 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Essen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"Boyd","sequence":"additional","affiliation":[{"name":"European Lung Foundation , Sheffield,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Coolen","sequence":"additional","affiliation":[{"name":"Department of Imaging and Pathology , KU Leuven, Leuven,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"De Bondt","sequence":"additional","affiliation":[{"name":"Department of Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital , Antwerp,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"De Ruysscher","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center+, GROW Research Institute , Maastricht,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Durieux","sequence":"additional","affiliation":[{"name":"Biblioth\u00e8que des Sciences de la Sant\u00e9, Universit\u00e9 Libre de Bruxelles (ULB) , Brussels,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Faivre-Finn","sequence":"additional","affiliation":[{"name":"The Christie NHS Foundation Trust, The University of Manchester , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean A","family":"Fennell","sequence":"additional","affiliation":[{"name":"Leicester Cancer Research Centre, University of Leicester and University of Leicester Hospitals NHS Trust , Leicester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francoise","family":"Galateau-Salle","sequence":"additional","affiliation":[{"name":"Department of Biopathology, National Reference Center for Pleural Malignant Mesothelioma and Rare Peritoneal Tumors MESOPATH , Centre Leon Berard, Lyon,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Greillier","sequence":"additional","affiliation":[{"name":"Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix Marseille University, Assistance Publique H\u00f4pitaux de Marseille , Inserm UMR1068, CNRS UMR7258, Marseille,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mir Ali","family":"Hoda","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Medical University of Vienna , Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Klepetko","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Medical University of Vienna , Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aude","family":"Lacourt","sequence":"additional","affiliation":[{"name":"University\u00a0Bordeaux, INSERM, Bordeaux Population Health Research Center , Team EPICENE, UMR 1219, Bordeaux,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"McElnay","sequence":"additional","affiliation":[{"name":"Newcastle University , Newcastle upon Tyne,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick A","family":"Maskell","sequence":"additional","affiliation":[{"name":"Academic Respiratory Unit, Bristol Medical School, University of Bristol , Bristol,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Mutti","sequence":"additional","affiliation":[{"name":"Teaching Hospital\u00a0Vercelli\/Gruppo Italiano , 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