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.