Both the British Thoracic Society 2007 guidelines (1) and the National Mesothelioma Framework (2) advocated the development of regional mesothelioma multidisciplinary team (MDT) meetings to discuss all mesothelioma cases on a regional basis. The Avon, Wiltshire and Somerset cancer network regional mesothelioma MDT team was established in 2008. We undertook a retrospective audit to evaluate its value.
Methods All patients referred for discussion in the 12-month period, 1st January 2009 to 31st December 2009, were included in the audit. The referral information and MDT outcomes were reviewed.
Results In total 76 patients were discussed; 66 males, median age 72 (40–88) and 10 females, median age 71.5 (46–88). WHO performance status was 0 in 15/67 (22%), 1 in 36/67 (53%), and 2 in 9/67 (13%). All 76 cases had a tissue diagnosis of mesothelioma made at their local hospital. Biopsy techniques included CT guided biopsy 28/68 (41%), local anaesthetic thoracoscopy 16/68 (24%) and VATS 19/68 (28%). All histological specimens were reviewed by the MDT. The final diagnosis was mesothelioma in 74/76 cases. The histological subtypes were; epithelioid 53 (69%), sarcomatoid 17 (22%), biphasic 3 (4%) and histiocytoid 1. In two (3%) cases, the diagnosis of mesothelioma was changed to severe reactive pleuritis only. Clinical follow-up and interval CT confirmed no evidence of malignancy. In addition, a further case with suspicious histology was confirmed to be reactive pleuritis only. Consideration of chemotherapy was felt appropriate in over two thirds of patients and patients could also have entered into a clinical trial. A total of 26/65 (40%) patients went on to have at least one cycle of chemotherapy and of these patients 19/26 (73%) entered a clinical mesothelioma trial.
Conclusions This audit supports the valuable role a regional mesothelioma MDT can play, both in the confirmation of the diagnosis and in evaluating eligibility for potential clinical trials.