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BTS statement on malignant mesothelioma in the UK, 2007

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The first British Thoracic Society (BTS) statement on mesothelioma was published in 2001 by a Working Party of the Standards of Care Committee of the BTS1 in response to a request by the National Health Executive in England. In the last 5 years enough progress has been made to justify the preparation of a second statement. The most significant updates are in sections reviewing radiology and biopsy techniques and interpretation, the potential use of tumour markers, chemotherapy, radical treatment and the roles of the specialist nurse and multidisciplinary team approach in management. Recent major clinical trials are also reviewed.

As before, this updated statement was written by a Working Party of clinicians with an interest and experience in the disease with the aim of compiling a document to assist in the management of pleural and peritoneal malignant mesothelioma in the UK. We were again assisted by co-opted specialists, including radiologists, pathologists, nurses and oncologists, whose full details are given in Appendix 1. The draft was reviewed by the whole membership of the BTS and also sent to expert groups and patient representatives for whose comments we are grateful. Our statement is the result of this consultation process.

This statement is compiled primarily for clinicians who may be involved in caring for patients with mesothelioma and is based on literature searches and reviews by members of the Working Party responsible for particular sections. However, like its predecessor, it is not strictly evidence-based as we did not attempt a comprehensive review of all available literature. Moreover, in most aspects of this subject there are still no randomised trials on which to base guidelines. The management of mesothelioma remains subject to debate and variations in practice, so we have retained the term “statement” rather than “guidelines” in this revision.

This statement should …

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Footnotes

  • Abbreviations:
    CALGB
    Cancer and Leukaemia Group B
    CT
    computed tomography
    EORTC
    European Organisation for Research and Treatment of Cancer
    EPP
    extrapleural pneumonectomy
    FDG
    18F-fluoro-deoxyglucose
    IIDB
    industrial injuries disablement benefit
    MARS
    Mesothelioma And Radical Surgery
    MRI
    magnetic resonance imaging
    PET
    positron emission tomography
    PS
    performance status
    RECIST
    Response Evaluation Criteria in Solid Tumours
    SMRP
    soluble mesothelin-related proteins
    SUV
    standardised uptake value
    VATS
    video-assisted thoracic surgery