Malignant Pleural Mesothelioma in Patients Who Previously Received Radiotherapy for Their First Malignant Tumor

Our plain-English summary of Malignant Pleural Mesothelioma in Patients Who Previously Received Radiotherapy for Their First Malignant Tumor, by I. Sekine, Y. Yamamoto, T. Suzuki, et al (Internal Medicine, 2021).

The study

• Authors: I. Sekine, Y. Yamamoto, T. Suzuki, H. Suzuki
• Journal: Internal Medicine
• Published: 2021;60(5):663-665
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This is an editorial, not an original study. It accompanied a case report in the same journal by Nakashima and colleagues about a Japanese patient whose malignant pleural mesothelioma developed 25 years after chest radiotherapy for Hodgkin's lymphoma, with no history of asbestos exposure. The editorial's authors compiled a table of 29 published cases of pleural mesothelioma in people who had radiotherapy for a first cancer and no asbestos exposure. In these cases, women made up 55%, the median age at diagnosis was 44, 66% had received radiotherapy before age 30, and the median time from radiotherapy to mesothelioma was 16 years. The authors wrote that these features differ from asbestos-related mesothelioma and underscore the association with radiotherapy. They found no link in these cases between radiation dose and time to mesothelioma. Using Bradford Hill's criteria for causation, they judged some criteria met and others not. They said a causal relationship has been difficult to establish in humans and that non-occupational asbestos exposure is always hard to rule out completely.

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: Editorial commenting on a case report, with a table of 29 published cases compiled from the literature and a discussion of Bradford Hill's causation criteria
• Who was studied: 29 published cases, including the new Japanese case, of malignant pleural mesothelioma in patients with a history of radiotherapy and no asbestos exposure
• Exposure: Radiotherapy for a first malignant tumor (in the index case, thoracic radiotherapy for Hodgkin's lymphoma), with no history of asbestos exposure
• Main results:
  • Women were 55% of the 29 cases. The authors compared this with under 20% of asbestos-related pleural mesothelioma cases.
  • Median age at mesothelioma diagnosis in the 29 cases was 44 years. The authors noted that asbestos-related cases are usually diagnosed in the late 50s or older.
  • 66% of the 29 patients had received radiotherapy for their first tumor before age 30
  • The median latency in the 29 cases was 16 years. The authors described this as shorter than the estimated 32-year median from first asbestos exposure to death from mesothelioma.
  • In the 29 cases, no association or tendency was seen between radiotherapy dose and latent period
  • Applying Bradford Hill's criteria, the authors judged that the radiotherapy–mesothelioma association clearly met some criteria, while others (strength, specificity, dose-response) needed further discussion or were not met
• The authors' conclusion: The authors concluded that the distinctive features of these cases, which differ from asbestos-related pleural mesothelioma, underscore the association between radiotherapy and pleural mesothelioma
• Limitations the authors state:
  • The authors stated that a causal relationship between radiotherapy and pleural mesothelioma has been difficult to establish in humans
  • The authors stated that non-occupational asbestos exposure (from the neighborhood or the household) is always difficult to exclude completely
  • The authors noted that many of these patients also received cytotoxic chemotherapy, which is generally considered carcinogenic

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: Pleural Mesothelioma.

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