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Introducing the new BTS guideline: the investigation and management of pleural malignant mesothelioma
  1. Ian Woolhouse1,
  2. Nick A Maskell2
  1. 1 Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 Academic Respiratory Unit, Southmead Hospital, University of Bristol, Bristol, UK
  1. Correspondence to Prof Nick A Maskell, Academic Respiratory Unit, University of Bristol, Bristol, BS10 5NB, UK; nick.maskell{at}

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Rationale for the new guideline

Malignant pleural mesothelioma (MPM) is an aggressive tumour with a poor prognosis. In 2012, 2535 mesothelioma deaths were reported in the UK, and the incidence is predicted to increase.

Only two-thirds of patients in England and Wales receive active anticancer treatment (chemotherapy, radiotherapy and surgery) for MPM and overall median survival is poor at 9.5 months, with 1-year and 3-year survival rates of only 41% and 12%, respectively.1 The poor survival rates, taken together with the significant variation in treatment and outcomes across the UK, highlight the need for an evidence-based guideline to facilitate the highest standards of care for all patients with mesothelioma in the UK.

In 2007, the British Thoracic Society (BTS) statement on mesothelioma was published in response to a request from the National Health Executive in England.2 While very informative, this statement did not constitute an evidence-based review of all the literature and a number of key clinical trials have been published in the last 10 years. In particular, there have been a number of landmark randomised controlled trials (RCTs) to assess the effectiveness of surgical treatments and prophylactic radiotherapy in MPM as well as studies of new biomarkers and novel chemotherapeutic agents.

BTS established a mesothelioma guideline development group, co-chaired by Professor Nick Maskell and Dr Ian Woolhouse, in 2014, tasked with producing an evidence-based guideline to assist with the investigation and management of pleural malignant mesothelioma. These guidelines are published as a supplement in this issue of Thorax.3 A summary of recommendations and good practice points is available in BMJ Open Respiratory Research.4


The evidence review methodology and grading of recommendations follows the National Institute for Health and Care Excellence accredited BTS guideline production process, which is based on Scottish Intercollegiate Guidelines Network methodology and adheres to the Appraisal …

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