STANDARDS, OPTIONS AND RECOMMENDATIONS (SOR) FOR CLINICAL CARE OF MALIGNANT PLEURAL MESOTHELIOMA

The ''Standards, Options and Recommandations'' (SOR), started in 1993, are a collaborative project between the Federation of the French Canc er Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. Th e main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal b y a multidisciplinary experts group, with feedback from specialists in cancer care delivery. The objectives are to develop a clinical practi ce guideline with definitions of Standards, Options and Recommendation s for the clinical care malignant pleural mesothelioma. Data have been identified by literature sen using Medline (1966-june 1997) and perso nal references lists. The main criteria considered were incidence risk factors, pronostic factors and efficacy of cancer treatment Once the guideline was defined the document runs submitted to 40 independent re viewers for peer review, and to the medical committees of the 20 Frenc h Cancer Centres for review and agreement The results are: 1) systemat ic assessment of (professional) exposure to asbestos is based on a sta ndardized interrogatory, completed by specific consultation for profes sional disease; 2) diagnostic and clinical staging is based on multipl e biopsies under thoracoscopy and thoracic scanner; 3) there is no ind ication for extemporaneous examination, immunocytochemistry should use cyto-keratine, EMA, vimentine, ACE, Leu-MI; 4) clinical care: the rec ommended staging classification is the IMIG (International Mesotheliom a Interest Group) classification; 5) validated independent pronostic f actors are stage of disease, patient's functional status and histologi c type (i.e. epithelial lesions are of better prognosis); 6) treatment is based on symptomatic and palliative treatment options. Anticancer treatments (surgery, chemotherapy, immunotherapy, radiotherapy) did no t show significant improvement of survival. The inclusion of patients in clinical trials is recommended.