Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 24, 2021; 12(8): 581-608
Published online Aug 24, 2021. doi: 10.5306/wjco.v12.i8.581
GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma
Javier Luna, Andrea Bobo, Joaquín José Cabrera-Rodriguez, María Pagola, Margarita Martín-Martín, María Ángeles González Ruiz, Miguel Montijano, Aurora Rodríguez, Lira Pelari-Mici, Almudena Corbacho, Marta Moreno, Felipe Couñago
Javier Luna, Department of Radiation Oncology, Institute of Oncohealth, Fundación Jiménez Díaz, Madrid 28040, Spain
Andrea Bobo, Aurora Rodríguez, Department of Radiation Oncology, Institution of Ruber Internacional Hospital, Madrid 28034, Spain
Joaquín José Cabrera-Rodriguez, Department of Radiation Oncology, Hospital Universitario de Badajoz, Badajoz 06080, Spain
María Pagola, Department of Radiation Oncology, Institution of Onkologikoa/Hospital Universitario Donostia, San Sebastián 20014, Spain
Margarita Martín-Martín, Lira Pelari-Mici, Department of Radiation Oncology, Institution of Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
María Ángeles González Ruiz, Department of Radiation Oncology, Institution of Hospital Universitario Virgen de la Macarena, Sevilla 41009, Spain
Miguel Montijano, Department of Radiation Oncology, Institution of Genesis care Spain, Madrid 28005, Spain
Almudena Corbacho, Department of Radiation Oncology, Institution of Hospital de Mérida, Mérida 06800, Spain
Marta Moreno, Department of Oncology, Institution of University Navarra, Clinical University, Pamplona 31008, Spain
Felipe Couñago, Department of Radiation Oncology, Institution of Hospital Universitario Quirónsalud and Hospital LaLuz, European University of Madrid, Madrid 28028, Spain
Author contributions: Luna J, Bobo A, Cabrera-Rodriguez JJ, Pagola M, Martín M, González Ruiz MA, Montijano M, Rodríguez A, Pelari L, Corbacho A, Moreno M, and Couñago F have contributed equally to this work in all aspects of manuscript preparation.
Conflict-of-interest statement: None of the authors declare any conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Javier Luna, MD, Staff Physician, Department of Radiation Oncology, Institute of Oncohealth, Fundación Jiménez Díaz, Avda, Reyes Católicos 2, Madrid 28040, Spain. jluna@fjd.es
Received: December 24, 2020
Peer-review started: December 24, 2020
First decision: May 4, 2021
Revised: May 12, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: August 24, 2021
Processing time: 242 Days and 6.1 Hours
Abstract

Malignant pleural mesothelioma (MPM) is a rare tumor with poor prognosis and rising incidence. Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement. Numerous therapeutic advances have been made in recent years, including the use of less aggressive surgical techniques associated with lower morbidity and mortality (e.g., pleurectomy/decortication), technological advancements in the field of radiotherapy (intensity-modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy, proton therapy), and developments in systemic therapies (chemotherapy and immunotherapy). These improvements have had as yet only a modest effect on local control and survival. Advances in the management of MPM and standardization of care are hampered by the evidence to date, limited by high heterogeneity among studies and small sample sizes. In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology, we review clinical, histologic, and therapeutic aspects of MPM, with a particular focus on all aspects relating to radiotherapy, including the current evidence base, associations with chemotherapy and surgery, treatment volumes and planning, technological advances, and reradiation.

Keywords: Malignant pleural mesothelioma; Chemotherapy; Surgery; Radiotherapy; Radiation techniques; Reradiation

Core Tip: Malignant pleural mesothelioma is a rare tumor that is very challenging to treat. Technological advances in surgery and radiotherapy are largely responsible for the marginally improved outcomes observed in recent years. Heterogeneity among studies and a lack of phase III randomized controlled trials are some of the main barriers to achieving more effective, standardized treatments. In this review article, we provide an in-depth analysis of changes in the clinical, histologic, and therapeutic profile of malignant pleural mesothelioma in recent decades and highlight the main research areas in this field.