Gamma knife radiosurgery of brain metastasis from malignant pleural mesothelioma--report of three cases with autopsy study in a case

Our plain-English summary of Gamma knife radiosurgery of brain metastasis from malignant pleural mesothelioma--report of three cases with autopsy study in a case, by T. Kobayashi, T. Tsugawa, C. Hashizume, et al (Nagoya Journal of Medical Science, 2014).

The study

• Authors: T. Kobayashi, T. Tsugawa, C. Hashizume, T. Toriyama, M. Asai, Y. Mori, Y. Shibamoto
• Journal: Nagoya Journal of Medical Science
• Published: 2014;76(1-2):187-93
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

The median survival time of malignant pleural mesothelioma (MPM) has been 9 months. Given the short survival, there have been only few cases in which brain metastases have been diagnosed and treated before death. Three cases of brain metastases treated by gamma knife radiosurgery (GKR) are reported. Case I showed a metastatic lesion in the right frontal lobe which was treated by GKR two years after diagnosis of MPM. The lesion markedly reduced and the symptoms were improved, But the patient died of progression of pleural tumor four months after GKR. A year and three months after the diagnosis, asymptomatic bifrontal lesions were treated with GKR. However, Case 2 died of abdominal mass a month after. Case 3 showed headache one and half year after the diagnosis. Three brain lesions were treated by GKR, which disappeared in 4 months. The patient died of new multiple brain metastases and periventricular dissemination seven months after. The autopsy revealed a MPM occupying the left pleural cavity. No neoplastic lesion was found in gamma knife-treated sites. The cause of death was the mass effect by new metastatic lesions. GKR was found effective also for the treatment of brain metastasis of MPM.

In plain English

This case report described three patients with malignant pleural mesothelioma whose cancer had spread to the brain. They were treated with gamma knife radiosurgery, a focused radiation treatment, at Nagoya Radiosurgery Center in Japan, at a marginal dose of 20 Gy. The patients were a 58-year-old woman whose asbestos exposure was not confirmed, a 65-year-old man with short-time asbestos exposure, and a 71-year-old man who had worked at a company with asbestos exposure for ten years from 1970. In the woman, a single large brain lesion shrank markedly by 3 months and her symptoms improved. No follow-up was possible for the 65-year-old man, who died one month after treatment. In the 71-year-old man, three brain lesions disappeared within 4 months, but he died seven months after treatment from new brain metastases. His autopsy found no tumor at the treated sites. Survival from diagnosis was 3 years, 1 year 4 months and 2 years 4 months (mean 26.7 months). The authors concluded that gamma knife radiosurgery was effective also for brain metastasis of this cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (series of three cases), with an autopsy study in one case
• Who was studied: Three patients with brain metastases from malignant pleural mesothelioma, treated at Nagoya Radiosurgery Center, Japan: Case 1, a 58-year-old woman; Case 2, a 65-year-old man; Case 3, a 71-year-old man. Two had symptoms from the brain metastases and one did not. Their mesothelioma was diagnosed in 2005, 2007 and 2008, and they died in 2008, 2008 and 2010.
• Exposure: Asbestos exposure varied: Case 3 worked at a company with asbestos exposure for ten years from 1970; Case 2 had short-time asbestos exposure; asbestos exposure was not confirmed in Case 1. No fiber type was named. The treatment studied was gamma knife radiosurgery (Leksell Gamma Knife Model 4C) at a prescribed marginal dose of 20 Gy.
• Main results:
  • Case 1: a single large brain lesion decreased markedly at 3 months after treatment, and symptoms improved.
  • Case 2: no follow-up study was available because the patient died early.
  • Cases 1 and 2 died of progression of the primary lesions, four months and one month after radiosurgery respectively.
  • Case 3: three brain lesions disappeared within 4 months of radiosurgery.
  • Case 3 died of new brain metastases and spread along the brain's ventricles (periventricular dissemination) seven months after radiosurgery.
  • At autopsy in Case 3, no tumor was found, either by eye or under the microscope, at the sites treated by radiosurgery.
  • In Case 3, a sign of tentorial herniation (brain compression) was found at autopsy and was thought to be the cause of death.
  • In Case 3, biopsy had shown the epithelial type of mesothelioma, but a sarcomatous component was predominant in the brain metastasis at autopsy.
  • Time from diagnosis of mesothelioma to death was 3 years, 1 year 4 months, and 2 years 4 months in the three patients (mean 26.7 months).
  • The three patients survived a mean of 4.3 months after radiosurgery.
• The authors' conclusion: The authors concluded that gamma knife radiosurgery was effective also for treating brain metastasis of malignant pleural mesothelioma. They wrote that the response of the lesions seemed similar to that of other malignant tumors.
• Limitations the authors state:
  • No follow-up was available for Case 2 because the patient died early.
  • In Case 3, no further brain MRI follow-up was done after the 4-month scan until the patient deteriorated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Autopsy, Median Overall Survival, Pleural Cavity.

Related studies

• Genetic and Immunohistochemical Profiling of Malignant Mesothelioma With Brain Metastasis: A Report of Two Cases — P.M. Harary, Y.S. Hori, et al. (2026)
• Brain Metastasis of Pleural Mesothelioma after a Subarachnoid Hemorrhage — A. Hirooka, A. Tamiya, et al. (2016)
• Brain metastasis in malignant pleural mesothelioma — A. Kawai, Y. Nagasaka, et al. (1997)
• Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma — L. Lang-Lazdunski, S. Barrington, et al. (2012)
• Brain metastasis in malignant pleural mesothelioma presenting as intratumoral hemorrhage — T. Ishikawa, H. Wanifuchi, et al. (2010)
• Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors — S. Hendry, R. Salgado, et al. (2017)

Browse more research in Nagoya Journal of Medical Science, or return to medical research.