GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma

Table 3 Eighth edition of the tumor, node, metastasis classification for mesothelioma

T	Primary tumor	N	Regional lymph nodes
Tx	Primary tumor cannot be assessed	Nx	Regional lymph nodes cannot be assessed
T0	No evidence of primary tumor	N0	No regional lymphnodemetastases
T1	Tumor limited to the ipsilateral parietal pleura with or without involvement of visceral pleuralmediastinal pleuradiaphragmatic pleura	N1	Metastases in the ipsilateral bronchopulmonary, hilar or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad or intercostal lymph nodes) lymph node)
T2	Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura) with at least one of the following features: Involvement of diaphragmatic muscle. Extension of tumor from visceral pleura into the underlying pulmonary parenchyma	N2	Metastases in the contralateral mediastinal, ipsilateral or contralateral supraclavicular lymph nodes
T3	Locally advanced but potentially resectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, visceral pleura) with at least one of the following features: Involvement of endothoracic fascia; Extension into the mediastinal fat; Non-transmural involvement of the pericardium; Solitary, completely resectable focus of Tumor extending into the soft tissues of the chest wall	M	Distant metastasis
T4	Locally advanced technically unresectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura) with at least one of the following features: Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction; Direct transdiaphragmatic extension of tumor to peritoneum; Direct extension of tumor to the contralateral pleura; Direct extension of tumor to mediastinal organs; Tumor extending through to the internal surface of the pericardium with or without pericardial effusion, or tumor involving the myocardium	M0	No distant metastasis
		M1	Distant metastasis present