Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma

Our plain-English summary of Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma, by L.R. Chirieac, J.A. Barletta, B.Y. Yeap, et al (Journal of Clinical Oncology, 2013).

The study

• Authors: L.R. Chirieac, J.A. Barletta, B.Y. Yeap, W.G. Richards, T. Tilleman, R. Bueno, E.H. Baldini, J. Godleski, D.J. Sugarbaker
• Journal: Journal of Clinical Oncology
• Published: 2013;31(36):4544-9
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Studies have reported an association between pleural diffuse malignant mesothelioma (PDMM) and chest radiation for lymphoma. The clinicopathologic characteristics of malignant mesotheliomas arising in these patients have not been established.

Patients And Methods: We studied 1,618 consecutive patients diagnosed with pleural PDMM from July 1993 to February 2008 and identified patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma. We evaluated the histology in the surgical resection specimens and compared clinicopathologic features with overall survival.

Results: We identified 22 patients who developed PDMM after chest radiation as part of their treatment for lymphoma (mean latency time, 21.4 years; 95% CI, 17.0 to 25.8 years). Asbestos bodies in lymphoma-associated PDMM were lower than in asbestos-associated PDMM (median count, 15 v 325 bodies, respectively; P < .001) and similar to an unexposed control group (median count, 15 v 10 bodies, respectively; P = .6). Seventeen lymphoma-associated PDMMs (77%) were epithelioid and five (23%) were biphasic. Seven PDMMs (32%) had unusual histologies (pleomorphic, myxoid, clear cell, and signet ring cell). Patients with lymphoma-associated PDMM were younger than patients with asbestos-associated PDMM (median age, 45 v 64 years, respectively; P < .001) and had a significantly longer overall survival time (median, 32.5 v 12.7 months, respectively; P = .018). In multivariate analysis, independent favorable predictors for overall survival were history of prior radiation (P = .022), female sex (P < .001), age ≤ 65 years (P = .005), cytoreductive surgery (P < .001), and epithelioid histology (P < .001).

Conclusion: Patients with lymphoma-associated PDMM are likely to have unusual histologic features, are significantly younger, and seem to have a longer overall survival compared with patients with asbestos-associated PDMM.

In plain English

This study reviewed 1,618 consecutive patients with pleural diffuse malignant mesothelioma diagnosed at Brigham and Women's Hospital, Boston, from July 1993 to February 2008. Of these, 22 had received chest radiation for Hodgkin lymphoma (20) or non-Hodgkin lymphoma (2). The authors labelled the other 1,596 asbestos-associated. Mesothelioma appeared a mean of 21 years after radiation (range 2 to 43 years). Radiation patients were younger (median age 45 v 64 years). Asbestos body counts were available for only 6 of the 22 and 476 of the 1,596 others. The radiation group's median was 15 bodies per gram of lung tissue, compared with 325 in the other group and 10 in 15 unexposed control samples. Some radiation patients did report asbestos exposure. Seven of the 22 tumors (32%) had unusual microscopic features. Median survival was 32.5 months in the radiation group v 12.7 months in the other group. Prior radiation remained linked to longer survival after adjustment. The authors concluded these patients are likely to have unusual features, are younger, and seem to survive longer. They could not assess risk by radiation dose.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-institution review of a consecutive series of patients with pleural diffuse malignant mesothelioma, identified from a surgical registry. Patients with prior chest radiation for lymphoma were compared with all other patients.
• Who was studied: 1,618 consecutive patients with pleural diffuse malignant mesothelioma (PDMM) diagnosed from July 1993 to February 2008 at Brigham and Women's Hospital, Boston. Of these, 22 had prior radiation for lymphoma ('lymphoma-associated PDMM') and 1,596 were labelled 'asbestos-associated PDMM'. Lung samples from 15 separate patients without PDMM or lymphoma served as an unexposed control group for asbestos body counts.
• Exposure: Chest radiation therapy for Hodgkin lymphoma (n = 20) or non-Hodgkin lymphoma (n = 2), given at a median age of 20 years. Asbestos body counts in lung tissue were also compared between groups.
• Main results:
  • In the 22 lymphoma-associated patients, mesothelioma developed after a mean latency of 21 years (range 2 to 43 years) from radiation.
  • Lymphoma-associated patients were younger than asbestos-associated patients: median age 45 v 64 years (P less than .001).
  • Median asbestos body count was 15 bodies in lymphoma-associated PDMM v 325 bodies in asbestos-associated PDMM (P less than .001). Table 1 gives the unit as bodies per gram.
  • Asbestos body counts were available for only 6 lymphoma-associated patients and 476 asbestos-associated patients.
  • Asbestos body counts in lymphoma-associated PDMM were similar to the unexposed control group: median 15 v 10 bodies (P = .6).
  • The authors noted that some patients in the lymphoma-associated group had a reported exposure to asbestos.
  • Of the lymphoma-associated tumors, 17 (77%) were epithelioid and 5 (23%) were biphasic, with none sarcomatoid. The authors reported the histologic type distribution as similar to asbestos-associated PDMM (P = .21).
  • Seven of the 22 lymphoma-associated tumors (32%) had unusual histologic patterns, including pleomorphic or rhabdoid cells, myxoid, clear cell and signet ring cell features.
  • Female-to-male sex ratios were similar: 1:3.4 in lymphoma-associated v 1:3.8 in asbestos-associated PDMM (P = .82).
  • Median overall survival was 32.5 months for lymphoma-associated PDMM v 12.7 months for asbestos-associated PDMM (P = .018).
  • In multivariate analysis, prior radiation for lymphoma remained an independent favorable predictor of survival (reciprocal hazard ratio 0.55; 95% CI 0.33 to 0.92; P = .022).
  • Other independent favorable predictors of overall survival in multivariate analysis were female sex, age 65 years or younger, complete macroscopic cytoreductive surgery and epithelioid histology.
• The authors' conclusion: The authors concluded that patients with lymphoma-associated PDMM are likely to have unusual histologic features, are significantly younger, and seem to have a longer overall survival than patients with asbestos-associated PDMM.
• Limitations the authors state:
  • The authors stated they could not comment on the risk of lymphoma-associated PDMM in relation to radiation dose. Available doses ranged from 30 to 46 Gy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Histology, Surgical Resection, Overall Survival, Latency, Asbestos Bodies, Epithelioid, Biphasic Mesothelioma.

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