GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

Table 2 Recommendations for the treatment of malignant pleural mesothelioma using the European Society of Medical Oncology levels of evidence and grades of recommendation adapted from the Infectious Diseases Society of America

Surgery	Chemotherapy	Radiotherapy
For palliation of pleural effusions when patients cannot benefit from chest tube drainage or chemical pleurodesis or when these are not successful (II, A)	The anti-folate/platinum doublet is the only approved standard of care for the first- and second-line treatment of unresectable mesothelioma (I, A); If available, bevacizumab, could be added to the standard treatment in selected patients (II, B)	For palliation of pain related to tumor growth radiotherapy can be considered (II, A)
To obtain diagnostic samples of tumor tissue and to stage the patient (II, A)	Maintenance therapy (switch or continuation) has not yet improved overall survival and patients should be included in these studies (II, A)	The use of radiotherapy to prevent growth in drainage tracts is not proved to be useful (III, A)
To be part of a multimodality treatment, preferably as part of a study (II, A)	Patients in good condition should be recommended to join studies in second line (II, A)	Radiotherapy can be given in an adjuvant setting after surgery or chemo-surgery to reduce the local failure rate. However, no evidence is available for its use as a standard treatment (II, A)
To perform a macroscopic complete resection by means of pleurectomy/decortication (III, C)		When postoperative radiotherapy is applied, strict constraints must be adhered to in order to avoid toxicity to neighboring organs, and special, tissue sparing, techniques should be used (II, A)

ESMO: European Society for Medical Oncology; IDSA: Infectious Diseases Society of America.