Malignant mesothelioma following radiation exposure

Our plain-English summary of Malignant mesothelioma following radiation exposure, by K.H. Antman, J.M. Corson, F.P. Li, et al (Journal of Clinical Oncology, 1983).

The study

• Authors: K.H. Antman, J.M. Corson, F.P. Li, J. Greenberger, A. Sytkowski, D.E. Henson, L. Weinstein
• Journal: Journal of Clinical Oncology
• Published: 1983;1(11):695-700
• Type of article: Case report
• Cited by: 80 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000591).

Abstract

Mesothelioma developed in proximity to the field of therapeutic radiation administered 10-31 years previously in four patients. In three, mesothelioma arose within the site of prior therapeutic radiation for another cancer. Mesothelioma in the fourth patient developed adjacent to the site of cosmetic radiation to a thyroidectomy scar. None of these four patients recalled an asbestos exposure or had evidence of asbestosis on chest roentgenogram. Lung tissue in one patient was negative for ferruginous bodies, a finding considered to indicate no significant asbestos exposure. Five other patients with radiation-associated mesothelioma have been reported previously, suggesting that radiation is an uncommon cause of human mesothelioma. Problems in the diagnosis of radiation-associated mesotheliomas are considered.

In plain English

This case report described four patients at the Dana Farber Cancer Institute/Brigham and Women's Hospital who developed malignant mesothelioma after earlier radiation and who did not recall any asbestos exposure. Three had been irradiated for another cancer. A man treated for seminoma and later lymphoma developed peritoneal mesothelioma at 55. A woman treated at age 6 for teratocarcinoma developed peritoneal mesothelioma at 24. A woman treated for breast cancer at 30 developed pleural mesothelioma at 40. The fourth patient had cosmetic radiation to a thyroidectomy scar at 29 and developed pleural mesothelioma at 55; her lung biopsy sections showed no ferruginous bodies. Across these four and five previously published cases, the interval from radiation to mesothelioma ranged from seven to 36 years (median 17). The authors could not exclude hidden asbestos exposure. They were less confident about the fourth case because her dose and field were unknown, and they noted that two patients were referred partly because of prior radiation. The authors concluded that mesothelioma should be considered in the differential diagnosis of radiation-associated cancers involving the pleura and peritoneum.

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: case report / case series of four patients, with a comparison table that also lists five previously published cases
• Who was studied: Four patients with malignant mesothelioma (one man, three women, aged 24 to 55 at diagnosis) among patients diagnosed with mesothelioma at the Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, between 1979 and 1981
• Exposure: Prior radiation, not asbestos. Patient 1 had radiotherapy for seminoma at 24 and for cecal lymphoma at 38 (doses unknown). Patient 2 had 3,800 rad to the pelvis and 2,000 rad to the upper abdomen at age 6. Patient 3 had 4,600 rad after breast cancer surgery at 30. Patient 4 had cosmetic radiation of unknown dose to the base of the neck after thyroidectomy at 29. None recalled asbestos exposure.
• Main results:
  • None of the four patients recalled contact with asbestos.
  • Patient 1, a man irradiated at ages 24 and 38, had epithelial-type malignant mesothelioma covering the peritoneal surface; the table gives intervals of 31 and 17 years and age 55 at diagnosis.
  • Patient 3, irradiated for breast carcinoma in 1969 at age 30, later developed a pleural tumor diagnosed as epithelial-type mesothelioma (age 40 at diagnosis per the table).
  • In patient 4, the lung biopsy showed no ferruginous bodies in hematoxylin and eosin-stained sections.
  • Among the nine radiation-associated cases (these four plus five published cases), the interval from radiation to mesothelioma ranged from seven to 36 years, with a median of 17 years.
  • Under the microscope, the radiation-associated mesotheliomas could not be told apart from those associated with asbestos.
• The authors' conclusion: The authors concluded that their findings suggest mesothelioma should be considered when diagnosing radiation-associated cancers that involve the pleura and peritoneum. They added that careful exposure histories in a large unselected series would help clarify how often radiation-associated mesothelioma occurs.
• Limitations the authors state:
  • Patients 2 and 3 were seen at this referral hospital partly because of their prior radiation, so the cases are not representative of mesothelioma patients generally.
  • The share of mesotheliomas in the general population associated with radiation exposure is unknown.
  • Unrecognized (occult) asbestos exposure, or an interaction between radiation and low-dose asbestos, could not be excluded in the nine irradiated patients.
  • For patient 4, radiation dose and field size could not be found, so her mesothelioma could not be attributed to radiation with the same confidence as in patients 1 to 3.
  • Other possible contributing factors were chemotherapy for an earlier cancer (patients 2 and 3) and inherited susceptibility to cancer, shown by multiple primary cancers (patients 1 and 3).

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Asbestos Exposure, Ferruginous Bodies.

Related studies

• Malignant peritoneal mesothelioma following radiotherapy for seminoma of the testis — R.J. Stock, Y.S. Fu, et al. (1979)
• A case of malignant pleural mesothelioma following exposure to atomic radiation in Nagasaki — M. Mizuki, K. Yukishige, et al. (1997)
• Radiation-induced mesothelioma among long-term solid cancer survivors: a longitudinal analysis of SEER database — A. Farioli, M. Ottone, et al. (2016)
• Malignant mesothelioma following treatment for Hodgkin's disease — L.B. Weissmann, J.M. Corson, et al. (1996)
• Localized benign pleural mesothelioma arising in a radiation field — J.K. Hill, R.F. Heitmiller, et al. (1997)
• Solid cancer mortality associated with chronic external radiation exposure at the French atomic energy commission and nuclear fuel company — C. Metz-Flamant, E. Samson, et al. (2011)

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