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Blood, 16 April 2009, Vol. 113, No. 16, pp. 3679-3681.
Prepublished online as a Blood First Edition Paper on February 20, 2009; DOI 10.1182/blood-2008-10-184705.


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CLINICAL TRIALS AND OBSERVATIONS

Brief report

Malignant mesothelioma after radiation treatment for Hodgkin lymphoma

Marie L. De Bruin1,*, Jacobus A. Burgers2,*, Paul Baas2, Mars B. van 't Veer3, Evert M. Noordijk4, Marieke W. J. Louwman5, Josée M. Zijlstra6, Hendrik van den Berg7, Berthe M. P. Aleman8, and Flora E. van Leeuwen1

Departments of 1 Epidemiology and 2 Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam; 3 Department of Hematology, Erasmus MC, Daniel den Hoed Cancer Center, Rotterdam; 4 Department of Radiotherapy, Leiden University Medical Center, Leiden; 5 Eindhoven Cancer Registry, Comprehensive Cancer Center South, Eindhoven; 6 Department of Hematology, Free University Medical Center, Amsterdam; 7 Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, Amsterdam; and 8 Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands

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.


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