➤ Since surgical cytoreduction is not expected to yield an R0 resection,
it is strongly recommended that multimodality therapy with
chemotherapy and/or radiation therapy should be administered. (Strong
Recommendation; EB-I)
➤ Chemotherapy may be given pre- or post-operatively in the context of
multimodality treatment. (Moderate Recommendation; EB-L)
➤ Adjuvant radiation therapy may be associated with a decreased risk of
local recurrence and may be offered to patients who have undergone
maximal cytoreduction. Treatment is complex, and it is recommended that
it should be delivered at experienced centers of excellence. (Moderate
Recommendation; EB-I)
➤ In the context of multimodality treatment, four to six cycles of
pemetrexed/platin based chemotherapy may be administered pre- or
post-operatively. (Moderate Recommendation; EB-I)
➤ Intracavitary therapies (chemotherapy or photodynamic therapy) may
be administered safely in experienced centers of excellence, preferably
in the context of a clinical trial. Their role in improving outcome is
indeterminate. (Weak Recommendation; EB-L)
➤ Tunneled pleural catheters are NOT recommended in patients who are
candidates for maximal surgical cytoreduction, because of the risk of
tumor implantation into the chest wall. (Strong Recommendation; EB-I)
➤ In patients who are not candidates for maximal surgical cytoreduction,
tunneled pleural catheters or pleurodesis (performed via chest tube
or thoracoscopy) may be offered. As noted above, these procedures
should be performed using the minimal number and size incisions.
Multidisciplinary input including surgical consultation with a center of
excellence should be sought to optimize management of a pleural effusion
and for consideration of investigational intracavitary therapies. (Strong
Recommendation; EB-I)
Radiation Therapy
➤ Prophylactic irradiation of intervention tracts should generally
NOT be offered patients to prevent tract recurrences. (Moderate
Recommendation; EB-H)
➤ It is recommended that adjuvant radiation should be offered to patients
who have resection of intervention tracts found to be histologically
positive. (Moderate Recommendation; EB-I)
Treatment
