The Association between Malignant Pleural Mesothelioma and Thoracic Radiation Therapy for Hodgkin's Lymphoma: The First Case Report in Japan

Our plain-English summary of The Association between Malignant Pleural Mesothelioma and Thoracic Radiation Therapy for Hodgkin's Lymphoma: The First Case Report in Japan, by K. Nakashima, Y. Demura, M. Oi, et al (Internal Medicine, 2021).

The study

• Authors: K. Nakashima, Y. Demura, M. Oi, M. Tabata, T. Tada, K. Shiozaki, M. Akai, T. Ishizuka
• Journal: Internal Medicine
• Published: 2021;60(5):771-775
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is mostly observed in patients with a history of asbestos exposure. Although other causes are rare, there are several reports of MPM induced by therapeutic radiation, mainly in Europe and North America. However, no such case has been reported in Japan. We herein report a 50-year-old Japanese woman who developed MPM 25 years after thoracic radiation therapy for Hodgkin's lymphoma. The patient had no history of exposure to asbestos; therefore, her history of radiation therapy was considered to be the cause of MPM. Clinicians should consider secondary MPM in patients with a history of thoracic radiation therapy.

In plain English

This article was a case report about one patient, which the authors described as the first such case reported in Japan. A 50-year-old Japanese woman with no history of asbestos exposure or smoking had been treated at age 25 for Hodgkin's lymphoma. She received chemotherapy and radiation therapy to the mediastinum (50 Gray in 25 fractions) and to the abdomen (56 Gray in 28 fractions). Five years after the radiation, a small left pleural effusion was seen. After 20 years of follow-up, the effusion and pleural thickening had increased. Imaging showed no pleural calcifications. A pleural biopsy led to a diagnosis of the epithelial type of malignant pleural mesothelioma, and no asbestos bodies were found. She was treated with carboplatin and pemetrexed. The authors considered the chest radiation therapy a cause of her mesothelioma. They noted that the tumor was limited to the irradiated area, that there was no evidence of asbestos exposure, and that she was relatively young for this disease. They also said it was difficult to conclude that radiation was the only cause. Environmental asbestos exposure, other suspected causes and her chemotherapy could not be fully ruled out.

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 50-year-old Japanese woman with no history of asbestos exposure or smoking, seen at a hospital in Japan
• Exposure: Radiation therapy for Hodgkin's lymphoma at age 25: 50 Gray in 25 fractions to the mediastinum (primary site) and 56 Gray in 28 fractions to the abdomen (recurrence site). She also received chemotherapy with mechlorethamine, vincristine, procarbazine and prednisolone. No asbestos exposure was reported.
• Main results:
  • A small left pleural effusion was found on chest CT five years after the radiation therapy
  • The pleural effusion and pleural thickness increased after 20 years of follow-up
  • There were no pleural calcifications
  • A full-thickness pleural biopsy with immunohistochemistry led to a diagnosis of the epithelial type of malignant pleural mesothelioma
  • No asbestos bodies were found in the biopsy specimen
  • The patient was treated with carboplatin and pemetrexed chemotherapy, followed by ongoing pemetrexed maintenance therapy
  • The tumor was limited to the area that had been irradiated
  • There was no evidence of asbestos exposure in her medical history
• The authors' conclusion: The authors considered the thoracic radiation therapy a cause of this patient's malignant pleural mesothelioma. Their reasons were that the tumor was limited to the irradiated area, there was no evidence of asbestos exposure, and the patient was relatively young.
• Limitations the authors state:
  • The authors stated it was difficult to conclude that thoracic radiation therapy was the only cause, in part because non-occupational environmental asbestos exposure could not be excluded
  • Other suspected causes of mesothelioma, such as carbon nanotubes, thorium dioxide, simian virus 40 and metals, could not be completely excluded
  • The patient's earlier chemotherapy may have been a factor in the development of the mesothelioma
  • The tumor was the usual epithelial type and did not show the unusual histological patterns reported in some radiation-associated cases

Topics

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

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

Related studies

• Malignant mesothelioma after radiation treatment for Hodgkin lymphoma — M.L. De Bruin, J.A. Burgers, et al. (2009)
• 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)
• Therapeutic radiation for lymphoma and risk of second primary malignant mesothelioma — E.T. Chang, E.C. Lau, et al. (2017)
• Malignant mesothelioma following treatment for Hodgkin's disease — L.B. Weissmann, J.M. Corson, et al. (1996)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)

Browse more research in Internal Medicine, or return to medical research.