Malignant mesothelioma following thoracic radiotherapy for lung cancer

Our plain-English summary of Malignant mesothelioma following thoracic radiotherapy for lung cancer, by S.M. Witherby, K.J. Butnor, S.M. Grunberg (Lung Cancer, 2007).

The study

• Authors: S.M. Witherby, K.J. Butnor, S.M. Grunberg
• Journal: Lung Cancer
• Published: 2007;57(3):410-3
• Type of article: Case report, Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

As the number of long-term cancer survivors increases, secondary malignancies are becoming a greater clinical issue. Although some of these malignancies may be related to common environmental exposures, a significant number are considered to be therapy-related. Pleural malignant mesothelioma is a neoplasm that may be related to asbestos exposure or radiation exposure. Previous reports of pleural mesothelioma as a second malignancy have tended to follow radiotherapy for extra-thoracic malignancies such as Hodgkin's disease, breast cancer and Wilms' tumor. We report the case of a 66-year-old woman with no prior asbestos exposure who developed pleural mesothelioma 17 years after pneumonectomy and adjuvant radiation therapy for non-small cell lung cancer. Opacification of the lung field from prior therapy made determination of the diagnosis more challenging. Secondary malignancies such as mesothelioma should be considered in patients who develop unexplained symptoms even long after treatment of a primary tumor.

In plain English

This article is a case report about one woman, from the University of Vermont. In 1988, at age 49, she had a right lung adenocarcinoma (a type of non-small cell lung cancer) removed by pneumonectomy, the removal of the whole lung. She then received radiotherapy to the right lung field, a total dose of 6000 rads. She had a 56 pack-year smoking history. Her social and occupational history showed no evidence of asbestos exposure. For the next 17 years she had no sign of the lung cancer returning. In December 2005, after breathlessness and abdominal pain, scans showed thick, rind-like thickening of the pleura (the lining around the lung) on the right side. No pleural plaques or interstitial fibrosis were seen. Because of her earlier surgery, the thickening could not be seen on chest X-ray. A needle biopsy showed epithelioid malignant mesothelioma, and the tissue staining was consistent with mesothelioma. She was treated with pemetrexed and cisplatin, declined steadily, and died in April 2006. The authors concluded that the mesothelioma was more likely a secondary cancer caused by her radiation therapy. They based this on her lack of known asbestos exposure, the long delay before the tumor appeared, and the tumor arising inside the area that had been irradiated.

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 (single patient)
• Who was studied: One woman treated in Vermont, USA. She presented in 1988 at age 49 with a right lung mass, and was diagnosed with pleural mesothelioma in December 2005.
• Exposure: Adjuvant radiotherapy to the right lung field after pneumonectomy for Stage III lung adenocarcinoma. The total dose was 6000 rads, given with a Cobalt 60 unit in 24 fractions over 46 days. No known asbestos exposure; no fiber type is involved.
• Main results:
  • The patient had a 56 pack-year smoking history, which she had recently stopped.
  • The patient had no known exposure to asbestos.
  • Over the 17 years after treatment, there was no evidence that the lung cancer had come back.
  • A CT scan of the chest showed rind-like thickening of the right pleura. No pleural plaques or interstitial fibrosis were seen.
  • A needle core biopsy of the thickened right pleura showed epithelioid malignant mesothelioma.
  • The tissue staining profile was consistent with mesothelioma.
  • The earlier lung carcinoma had not invaded the pleura.
  • Because of the earlier pneumonectomy, the pleural thickening could not be seen on chest X-ray. It was first noticed on an abdominal CT scan.
  • She was treated with pemetrexed and cisplatin, had a steady downhill course with complications, and died in April 2006.
• The authors' conclusion: The authors concluded that this was more likely a secondary mesothelioma caused by radiation therapy for lung cancer 17 years earlier. Their reasons were that she had no known asbestos exposure, the latency was appropriate, and the tumor arose within the radiated field. They advised that clinicians stay alert for late secondary cancers after lung cancer treatment.

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, Lung Cancer, Environmental Exposure, Neoplasm, Asbestos Exposure, Pleural Mesothelioma, Pneumonectomy, Non-Small Cell Lung Cancer.

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