Elsevier

Lung Cancer

Volume 57, Issue 3, September 2007, Pages 410-413
Lung Cancer

Case report
Malignant mesothelioma following thoracic radiotherapy for lung cancer

https://doi.org/10.1016/j.lungcan.2007.03.016Get rights and content

Summary

As the number of long-term cancer survivors increases, secondary malignancies are becoming a greater clinical issue. Although some of these malignancies may be related to common environmental exposures, a significant number are considered to be therapy-related. Pleural malignant mesothelioma is a neoplasm that may be related to asbestos exposure or radiation exposure. Previous reports of pleural mesothelioma as a second malignancy have tended to follow radiotherapy for extra-thoracic malignancies such as Hodgkin's disease, breast cancer and Wilms’ tumor. We report the case of a 66-year-old woman with no prior asbestos exposure who developed pleural mesothelioma 17 years after pneumonectomy and adjuvant radiation therapy for non-small cell lung cancer. Opacification of the lung field from prior therapy made determination of the diagnosis more challenging. Secondary malignancies such as mesothelioma should be considered in patients who develop unexplained symptoms even long after treatment of a primary tumor.

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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