Malignant mesothelioma after radiation treatment for Hodgkin lymphoma

Our plain-English summary of Malignant mesothelioma after radiation treatment for Hodgkin lymphoma, by M.L. De Bruin, J.A. Burgers, P. Baas, et al (Blood, 2009).

The study

• Authors: M.L. De Bruin, J.A. Burgers, P. Baas, M.B. van 't Veer, E.M. Noordijk, M.W. Louwman, J.M. Zijlstra, H. van den Berg, B.M. Aleman, F.E. van Leeuwen
• Journal: Blood
• Published: 2009;113(16):3679-81
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is a relatively uncommon malignancy. Although the pathogenesis is primarily related to asbestos, the disease may be associated with radiation exposure. Recently, increased risks for second primary mesothelioma after radiation for lymphoma have been reported. Because these findings are based on small numbers of patients, they need to be confirmed. We examined mesothelioma risk in 2567 5-year survivors of Hodgkin lymphoma. The risk was almost 30-fold increased in Hodgkin lymphoma patients treated with irradiation compared with the general population. Although histology and survival of the mesothelioma cases were comparable with cases from the general population, asbestos exposure and the proportion of males were lower than expected. The evidence for radiotherapy as cause for mesothelioma independent of exposure to asbestos is expanding, and the diagnosis of mesothelioma should be kept in mind whenever related symptoms arise in patients who had previous irradiation.

In plain English

This report followed 2567 Dutch patients who survived at least 5 years after Hodgkin lymphoma treatment given before age 51, between 1965 and 1995. After a median follow-up of 18.1 years, 13 (8 men, 5 women) developed pleural mesothelioma, against 0.51 expected from general-population rates: a standardized incidence ratio (SIR) of 25.7 (95% confidence interval 13.7-44.0). Among radiotherapy-treated patients, the SIR was 29.4 in the text and 29.5 in the table (15.7-50.4). It was 44.8 (23.2-78.3; 12 cases) for radiotherapy plus chemotherapy and 5.8 (0.2-32.1; one case) for radiotherapy alone. None of 232 patients given chemotherapy alone developed mesothelioma. Women's SIR was 85.2 (27.6-199) and men's 17.9 (7.7-35.3), but absolute excess was 3.0 cases per 10 000 patients per year in women and 3.9 in men. Twelve tumors arose inside the radiation field. Seven of the 13 had previous asbestos exposure (6 occupational, 1 environmental), fewer than the 85% the authors expected among mesothelioma patients. The authors concluded that evidence for radiotherapy causing mesothelioma independent of asbestos is expanding, but the absolute number of patients involved is low.

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: Cohort study comparing mesothelioma incidence in Hodgkin lymphoma survivors with general-population rates (standardized incidence ratios and absolute excess rates); published as a brief report
• Who was studied: 2567 patients treated for Hodgkin lymphoma before age 51, between 1965 and 1995, at 5 cancer centers or university hospitals in The Netherlands and at hospitals affiliated with the Eindhoven Cancer Registry. All had survived at least 5 years. Median age at first treatment was 27.4 years (range 3 to 50).
• Exposure: Radiotherapy and/or chemotherapy for Hodgkin lymphoma. Radiation fields and doses were taken from radiotherapy charts. Previous asbestos exposure was identified from medical records and general practitioners. No fiber types were named.
• Main results:
  • After a median follow-up of 18.1 years, 13 of 2567 patients (8 men, 5 women) developed mesothelioma.
  • Whole cohort: SIR 25.7 (13.7-44.0) compared with the general population, with 13 cases observed against 0.51 expected.
  • Whole cohort: the absolute excess was 3.5 mesothelioma cases per 10 000 patients per year.
  • Patients treated with radiotherapy: SIR 29.4 (15.7-50.4) in the text; Table 1 gives 29.5 (15.7-50.4) for radiotherapy with or without chemotherapy.
  • Radiotherapy plus chemotherapy: 12 cases among 1605 patients, SIR 44.8 (23.2-78.3).
  • Radiotherapy alone: 1 case among 730 patients, SIR 5.8 (0.2-32.1).
  • None of the 232 patients treated with chemotherapy only developed mesothelioma.
  • Women: SIR 85.2 (27.6-199). Men: SIR 17.9 (7.7-35.3).
  • Absolute excess rate per 10 000 patients per year: women 3.0 (0.9-7.1); men 3.9 (1.6-7.9).
  • Patients followed 25 years or more after treatment: SIR 58.4 (23.5-120).
  • Among the 13 cases, median time from Hodgkin lymphoma treatment to mesothelioma was 27.7 years.
  • 12 of the 13 tumors developed within the radiation field.
  • 7 of the 13 mesothelioma patients had previous asbestos exposure: 6 occupational, 1 environmental.
  • The cases were mostly of the epithelial subtype, and median survival was 10.2 months.
  • Compared with all mesothelioma cases newly diagnosed in The Netherlands from 1989 to 2005, the cohort's cases were younger (69% vs 23% younger than 60 years) and more often female (38% vs 13%).
• The authors' conclusion: The authors concluded that the evidence for radiotherapy as a cause of mesothelioma independent of asbestos exposure is expanding, but that the absolute number of patients involved is low. They also wrote that their results suggest a potential interaction with chemotherapy or asbestos.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Histology, Asbestos Exposure.

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