Malignant Pleural Mesothelioma Post-Irradiation Treatment for Hodgkin’s
Lymphoma
Thea Price MD, R.V. Sooppan MD, Michael Walker MD
Department of Thoracic Surgery
Thomas Jefferson University Hospital
Eastern Cardiothoracic Surgical Society Annual Meeting
October 23-36, 2013
Introduction: Malignant Pleural Mesothelioma (MPM)
Long latency period (10-40 years)
85% from environmental exposure (asbestos)
15% arise without environmental exposure
2nd primary malignancies
30-fold increase risk after irradiation (XRT) treatment for Hodgkin Lymphoma (HL)
Asbestos
Patient Data
Patient Age of HL Dx
Age of MPM
Dx
XRT
Chemo Asbestos exposure Type MPM
1) Female 17 65 + - - Epithelioid
2) Male 16 53 + - - Epithelioid
Radiology
Patient 2: PET Patient 2: PET
Patient 1 : PET
Conclusions Extended Field Radiation utilized in the 1970s and 1980s, especially in
adolescents, significantly raises the risk of second primary malignancy ≥ 30 years later
77% of deaths >10 from HL related to longterm effects of therapy*
Often widespread invasion at diagnosis
Natural history of death within 4-12 months of diagnosis
Vitally important to recognize this risk in HL patients presenting with respiratory symptoms or chest pain
Acknowledgements Dr. Michael Walker, MD, Thoracic Surgery Department, Main line Health, Pennsylvania Jefferson University Hospitals, Philadelphia, Pennsylvania
Yung L, et al. Long term outcome in adolescents with Hodgkin's lymphoma: poor results using regimens designed for adults. Leuk Lymphoma. 2004 Aug;45(8): 1579-85.