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NCCN Flash UpdatesTM: NCCN Guidelines® and NCCN Compendium® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Malignant Pleural Mesothelioma. These NCCN Guidelines® are currently available as Version 1.2015.

  • Principles of Surgery (MPM-C)
    • Bullet 3 modified: The goal of surgery is complete gross cytoreduction of the tumor. The goal of cytoreductive surgery is “macroscopic complete resection.” In other words, removal of ALL visible or palpable tumors. In cases where this is not possible, such as in multiple sites of chest wall invasion, surgery should be aborted.
    • Bullet 4 modified: The surgical choices are: 1) pleurectomy/decortication (P/D) with mediastinal lymph node sampling, which is defined as complete removal of the pleura and all gross tumor; and 2) extrapleural pneumonectomy (EPP), which is defined as en-bloc resection of the pleura, lung, ipsilateral diaphragm, and, often, pericardium. Mediastinal node sampling should be performed. The, with a goal is to obtain at least 3 nodal stations, if technically feasible.
    • Bullet 5 modified: Numerous studies have defined sarcomatoid and mixed tumors as a poor prognostic factors for any surgical or non-surgical treatment of MPM and is a contraindication to after EPP.
    • Bullet 6 modified: For early disease (confined to the pleural envelope, no N2 lymph node involvement) with favorable histology (epithelioid), PD may be safer than EPP but it is unclear which operation is oncologically better. There is controversy regarding choice of procedure that needs to be weighed, taking into account tumor histology, distribution, patient pulmonary reserve, and availability of adjuvant and intraoperative strategies. P/D should be the first option.and EPP are each reasonable surgical treatment options and shouldmay be considered in select patients for complete gross cytoreduction.
    • Bullet 7 modified: If N2 disease or a mixed histology tumor is identified, prognosis with surgery (and other therapy) is substantially diminished. Surgical resection should only be considered in the setting of a clinical trial or at a center with expertise in MPM.
    • Bullet 8 added: If technically appropriate for even more advanced disease, lung sparing operations like pleurectomy/decortication reduces the risk for perioperative mortality and may be acceptable in terms of achieving complete macroscopic resection.
    • Bullet 9 added: Intraoperative adjuvant therapy, such as heated chemotherapy or photodynamic therapy, is still under investigation but may be considered as part of a reasonable multidisciplinary approach to this locally aggressive disease.

For the complete updated versions of the NCCN Guidelines, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit

To access the NCCN Biomarkers Compendium®, please visit

To view the NCCN Guidelines for Patients®, please visit

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