Turkish Clinical Guideline for Malignant Pleural Mesothelioma

Objective: Malignant Pleural Mesothelioma (MPM) is a an important public health problem in Turkey. In order to establish a common ground, Turkish Mesothelioma Working Group was established in 2011. Currently 150 academicians/researches from various disciplines (pulmonary medicine, thoracic surgery, medical and radiation oncology, radiology, pathology, nuclear medicine, public and mineralogy) from 40 universities, 5 training and 2 occupational hospitals have joined this group. The main aim of this effort was to finalize a “Guide for Diagnostic and Therapeutic Standards” that would be used in the epidemiologic evaluation, clinical diagnosis and treatment of MPM patients.

Methods: The group made several consecutive meetings and established panels on four subgroups which were epidemiology, clinical evaluation and diagnosis, pathology and treatment to finalize a guideline. The titles, subtitles and involving academicians/researchers were formed according to the recommendations by the participants. Each panel developed PICOT questions according to the existing literature and proposed their standards. A general council meeting finalized the text of the guidelines, recommendations by the group and the algorithms.

Results: Environmental exposure is a significant problem in rural areas in Turkey besides occupational exposure. A very limited group of people were also exposed to erionite which is a very potent carcinogen. Environmental exposure starts with birth and thus average age of patients is younger with an equal gender distribution. If there is any history of asbestos or erionite exposure and associated pleural effusion or chest pain, MPM should be ruled out using invasive diagnostic procedures. A multidisciplinary diagnosis and treatment team should evaluate the patient and organize the subsequent treatment. Diagnostic and treatment procedures should be performed according to clinical protocols.

Conclusion: Current guideline is expected to establish a basic standard for the diagnosis and treatment of MPM patients in Turkey.