Malignant mesothelioma after radiation treatment for Hodgkin lymphoma

Abstract

Malignant mesothelioma is a relatively uncommon malignancy. Although the pathogenesis is primarily related to asbestos, the disease may be associated with radiation exposure. Recently, increased risks for second primary mesothelioma after radiation for lymphoma have been reported. Because these findings are based on small numbers of patients, they need to be confirmed. We examined mesothelioma risk in 2567 5-year survivors of Hodgkin lymphoma. The risk was almost 30-fold increased in Hodgkin lymphoma patients treated with irradiation compared with the general population. Although histology and survival of the mesothelioma cases were comparable with cases from the general population, asbestos exposure and the proportion of males were lower than expected. The evidence for radiotherapy as cause for mesothelioma independent of exposure to asbestos is expanding, and the diagnosis of mesothelioma should be kept in mind whenever related symptoms arise in patients who had previous irradiation.

Cardio-Oncology

“…A recent retrospective study demonstrated that 2201 Hodgkin's survivors treated between 1965 and 1995 had increased standardized incidence ratio of 2.2 for stroke and 3.1 for transient ischemic attack compared with a general population. 115 Hypertension, diabetes mellitus, and hypercholesterolemia were associated with increased occurrence of ischemic cerebrovascular disease while chemotherapy treatment was not. 115 Beyond Hodgkin's lymphoma survivors, a study of childhood survivors of acute lymphoblastic leukemia, and brain tumors who received radiation, showed a significantly higher relative risk of stroke at a mean follow-up of 18 years.…”

“…115 Hypertension, diabetes mellitus, and hypercholesterolemia were associated with increased occurrence of ischemic cerebrovascular disease while chemotherapy treatment was not. 115 Beyond Hodgkin's lymphoma survivors, a study of childhood survivors of acute lymphoblastic leukemia, and brain tumors who received radiation, showed a significantly higher relative risk of stroke at a mean follow-up of 18 years. 116 Thus, in cancer survivors treated with radiation, we must be aware of the spectrum of vascular disease, both cardiovascular and cerebrovascular and aggressively treat modifiable risk factors.…”

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

“…A detailed description of patient selection, data collection, and treatments has been published previously 2,9,[13][14][15] as well as assessment of cardiovascular events during follow-up. 9 Patients were eligible for this study if (1) they survived at least 5 years after HL diagnosis; (2) they were diagnosed with HL before the age of 51 years; (3) HL was their first primary malignancy (except for nonmelanoma skin cancer or carcinoma in situ of the cervix uteri or the breast); and (4) radiotherapy for HL was the only radiotherapy given to the neck or trunk prior to the cutoff date, which was defined as date of HF for the cases, whereas for each control it was defined as date of HL diagnosis plus a time interval equal to the interval from date of HL diagnosis to date of HF diagnosis of the corresponding case.…”

Novel systemic therapy against malignant pleural mesothelioma

“…Risk factors for mesothelioma also include environmental, occupational, and para-occupational exposure to asbestos and other mineral fibers such as erionite (8). Prior chest radiation therapy or occupational radiation also increases the risk for developing mesothelioma (9)(10)(11)(12)(13)(14)(15). Familial variants of mesothelioma exist as well: for example, two families with strong family history of mesothelioma without an associated history of exposure to asbestos or other mineral fibers were found to have familial mutations in BRCA associated protein 1 (BAP1), a tumor suppressor gene, that either affects the gene's promoter or forms a premature stop codon (16).…”