Case reportMalignant mesothelioma following thoracic radiotherapy for lung cancer
Introduction
As the number of cancer survivors increases, the rate of post-cancer and post-therapy complications, including secondary malignancies, is also increasing. In childhood cancer survivors the risk of a second malignancy is five times the risk of malignancy in the general population [1]. In 15 year survivors of Hodgkin's disease in particular, an 18.5-fold increase risk of secondary malignancy has been reported [2].
Although the appearance of a second malignancy may be related to a common environmental exposure or may be coincidental, cancer therapy itself may increase the risk of secondary malignancy. Radiation exposure has long been known to be potentially carcinogenic. Reports of malignancies attributable to radiation therapy first appeared shortly after the initial use of radiation therapy to treat cancer [3]. Observations of skin cancers and leukemias in radiation technicians and radiologists were followed by reports of secondary malignancies in patients treated with radiation. The most common secondary malignancies associated with radiation exposure are hematologic, including acute leukemias and myelodysplastic syndrome, which usually occur in the first years after exposure. Solid tumors, including lung cancer and sarcomas, have also been associated with radiation exposure, but occur after a significantly longer latency period and this risk continues for several decades [4].
Malignant mesothelioma is an uncommon neoplasm that has been linked to prior radiation therapy for various tumor types, with Hodgkin's disease being the most common primary malignancy. However, in the setting of a prior lung cancer, distinguishing between recurrence of lung cancer and a secondary pleural mesothelioma could be especially difficult. In the present report, the case of a woman who developed mesothelioma after radiation therapy for lung cancer is described.
Section snippets
Case report
In 1988, a 49-year-old woman presented with dyspnea and was found to have a right lung mass. She had a 56 pack-year history of smoking, recently discontinued. Social and occupational history did not reveal evidence of environmental or occupational exposure to asbestos. Pneumonectomy resulted in resection of Stage III adenocarcinoma of the right lung (T2N2M0, apical mass 5.0 cm × 3.9 cm with ipsilateral mediastinal and subcarinal lymphadenopathy). She received adjuvant radiotherapy to the right lung
Discussion
Malignant mesothelioma is a rare neoplasm, particularly in women. In 2003, 560 cases of malignant mesothelioma of the pleura and peritoneum in women were reported in the SEER database. Unlike men, whose higher incidence of mesothelioma varies with birth cohort and is associated with occupational asbestos exposure, the lifetime probability of mesothelioma in U.S. women is 3.6 × 10−4[5]. Eighty percent of mesothelioma cases occur 20–50 years following asbestos exposure while the remaining 20% are
Conclusion
As long-term survivorship after lung cancer increases, providers must be vigilant about surveillance for late complications of therapy, including secondary malignancies. This possibility should be considered in the evaluation of unusual late symptoms, such as anemia, abdominal discomfort or respiratory distress.
Conflict of interest
The authors have no conflicts of interest. No funding was received for this study.
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