Malignant mesothelioma following treatment for Hodgkin's disease

Our plain-English summary of Malignant mesothelioma following treatment for Hodgkin's disease, by L.B. Weissmann, J.M. Corson, A.I. Neugut, et al (Journal of Clinical Oncology, 1996).

The study

• Authors: L.B. Weissmann, J.M. Corson, A.I. Neugut, K.H. Antman
• Journal: Journal of Clinical Oncology
• Published: 1996;14(7):2098-100
• Type of article: Case report
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Asbestos exposure is the major known risk factor for mesothelioma, but several case reports have suggested a link between radiation therapy and subsequent development of malignant mesothelioma. This report explores a possible association between radiation therapy for Hodgkin's disease and mesothelioma.

Patients And Methods: Four cases of malignant mesothelioma were observed following Hodgkin's disease at the Mesothelioma Clinic of the Dana-Farber Cancer Institute. A fifth such patient was found after a review of the literature.

Results: In all five cases, the mesothelioma arose in the field of prior radiotherapy. No history of asbestos exposure was elicited by careful questioning or by review of chest radiographs. Examination of lung tissue in one patient showed 250 ferruginous bodies per gram of lung tissue, consistent with no significant prior exposure. The mean interval between radiation treatment for Hodgkin's disease and development of mesothelioma was 15 years, which emphasizes the need for continued follow-up and evaluation of these patients and supports a causal relationship.

Conclusion: Mesothelioma may need to be added to the list of second malignancies that arise following radiation therapy for Hodgkin's disease. Further support is given to a causal link between radiation exposure and mesothelioma.

In plain English

This case series came from the Mesothelioma Clinic of the Dana-Farber Cancer Institute. Reviewing charts of patients referred from 1982 to 1993, the authors found four people who developed malignant mesothelioma after radiation therapy for Hodgkin's disease, and they added one previously published case. Three of the five had also received chemotherapy. The mesothelioma was pleural in three and peritoneal in two, and in all five it arose within the area that had been irradiated. Mesothelioma appeared a median of 14 years (range 7 to 25) after Hodgkin's treatment. The median age at mesothelioma diagnosis was 34, which the authors called significantly less than the median of 65 in the Connecticut Tumor Registry. No patient recalled asbestos exposure or showed asbestosis on chest X-rays, though one had worked as a fireman. That patient's lung tissue had fewer than 250 ferruginous bodies per gram, which the authors called consistent with normal population exposure. The authors concluded that radiation therapy should be added to asbestos exposure as a risk factor for mesothelioma. The report describes individual patients and does not measure a rate.

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 series: four patients found by retrospective chart review at one clinic, plus one case from the published literature
• Who was studied: Four patients referred to the Dana-Farber Cancer Institute Mesothelioma Clinic (Boston) from 1982 to 1993 who had earlier been treated for Hodgkin's disease (three men, one woman). One previously reported patient (a man, Brenner et al) was added.
• Exposure: Radiation therapy for Hodgkin's disease. Doses given were 30 Gy (case 1), 35 Gy (case 2) and 35 Gy (case 4), and no dose was given for case 3. Three of the five patients also received chemotherapy. The study did not examine any asbestos fiber type; none of the patients reported asbestos exposure.
• Main results:
  • In all five patients, the mesothelioma developed within the field of the earlier radiation therapy.
  • Two of the clinic patients (cases 1 and 3) had peritoneal mesothelioma. The other two clinic patients (cases 2 and 4) and the published case had pleural mesothelioma.
  • Across the five patients, the median time from Hodgkin's disease treatment to mesothelioma was 14 years (range 7 to 25).
  • The median age at mesothelioma diagnosis in the five patients was 34 years (range 32 to 46). The authors described this as significantly less than the median age of 65 in the Connecticut Tumor Registry.
  • None of the patients recalled asbestos exposure, and none had evidence of asbestosis on chest radiographs.
  • Patient no. 2 worked as a fireman but recalled no known asbestos exposure. No pleural plaques were seen at surgery. His lung tissue had fewer than 250 ferruginous bodies per gram, which the authors called consistent with normal population exposure.
• The authors' conclusion: The authors concluded that the lack of known asbestos exposure, the younger age at diagnosis and the location of disease in the radiation field all suggest radiation was a cause of these mesotheliomas. In their view, radiation therapy should be added to asbestos exposure as a risk factor for mesothelioma, and mesothelioma should be considered in the differential diagnosis of patients previously treated for Hodgkin's disease.

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, Asbestos Exposure, Dana Corporation, Chest X-Ray, Ferruginous body.

Related studies

• Malignant mesothelioma after radiation treatment for Hodgkin lymphoma — M.L. De Bruin, J.A. Burgers, et al. (2009)
• Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature — M. Bendek, M. Ferenc, et al. (2010)
• Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma — L.R. Chirieac, J.A. Barletta, et al. (2013)
• Newly discovered quick, non-invasive screening method of bone marrow malignancies including various leukemias, Hodgkin's lymphoma, non-Hodgkin's lymphoma, & multiple myeloma by abnormality of small rectangular area within bone marrow organ representation areas of the face — Y. Omura, B. O'Young, et al. (2012)
• Malignant mesothelioma following radiation exposure — K.H. Antman, J.M. Corson, et al. (1983)
• The Association between Malignant Pleural Mesothelioma and Thoracic Radiation Therapy for Hodgkin's Lymphoma: The First Case Report in Japan — K. Nakashima, Y. Demura, et al. (2021)

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