Primary pericardial malignant mesothelioma and response to radiation therapy

Our plain-English summary of Primary pericardial malignant mesothelioma and response to radiation therapy, by K.A. Reardon, M.A. Reardon, C.A. Moskaluk, et al (Rare Tumors, 2010).

The study

• Authors: K.A. Reardon, M.A. Reardon, C.A. Moskaluk, W.W. Grosh, P.W. Read
• Journal: Rare Tumors
• Published: 2010;2(3):e51
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of a primary pericardial malignant mesothelioma. A 59-year-old male presented with episodic chest pain and dyspnea on exertion. Cardiac magnetic resonance imaging revealed a large mass in the pericardium attached to the right ventricle. Partial resection of the mass was undertaken revealing malignant mesothelioma, byphasic type. The patient was treated with chemotherapy intermittently over a period of 3 years, but his disease continued to progress. The patient was then treated with definitive radiation therapy to 64 Gy to the primary tumor using a six field 3D conformal technique. The patient remains free of progressive disease 86 months from the time of diagnosis and 50 months from the completion of his radiotherapy.

In plain English

This article is a case report from the University of Virginia about one patient: a 59-year-old African American man with malignant mesothelioma arising in the pericardium, the sac around the heart. In April 2003 the patient went to the emergency room with episodic chest pain and worsening shortness of breath on exertion. Imaging showed a mass in the pericardium attached to the right ventricle. Surgeons removed part of the tumor but could not remove all of it, because it was stuck to the heart muscle. Pathology showed malignant mesothelioma of the biphasic type. Over about three years the patient received three courses of chemotherapy, and the disease grew again after each. In 2006 the patient received radiation therapy, 64 Gray in 32 fractions, and afterwards the mass measured one-fifth of its earlier volume. At the time of the report, 86 months after diagnosis and 50 months after radiation, there was no evidence of progressive disease. The article gives no asbestos exposure history for this patient. The authors recommended considering curative high-dose radiation as a reasonable option for unresectable or recurrent primary pericardial mesothelioma.

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 (single patient)
• Who was studied: One 59-year-old African American man with hypertension and obesity, who presented to the emergency room on April 27, 2003; treated at the University of Virginia, Charlottesville, VA, USA
• Exposure: Not reported. The article gives no asbestos or other exposure history for this patient. The discussion states, citing other publications, that the role of asbestos in pericardial mesothelioma is unclear.
• Main results:
  • After partial surgical removal of the tumor, pathology reported malignant mesothelioma, biphasic type (epithelial and spindle cell). Complete removal was not possible because the tumor adhered to the right ventricular muscle.
  • First-line chemotherapy (eight cycles of gemcitabine and cisplatin, ending March 2004) gave a good partial response. The disease later progressed despite six cycles of gemcitabine and carboplatin and two cycles of pemetrexed (spelled 'permextred' in the text).
  • The patient received radiation therapy from March 2, 2006 to April 18, 2006: a total of 64 Gray in 32 fractions of 2 Gray each, using a 6-field 3D conformal technique.
  • On MRI after radiation, the mass measured one-fifth of its pretreatment volume.
  • At 40 months after radiation, imaging showed only anterior pericardial thickening of up to 8 mm, unchanged since December 2007 and with no discrete mass. This was felt most likely to represent changes caused by the radiation.
  • At the time of the report, the patient was 86 months from diagnosis and 50 months from the end of radiation therapy, with no evidence of progressive disease.
  • The patient had no late lung radiation toxicity. Cardiac ejection fraction was 48% (normal 56-78%) in February 2010, compared with 50-55% before radiation in February 2006.
• The authors' conclusion: The authors reported a complete clinical response and local control at 50 months after high-dose radiation in this patient. They noted that only modest benefits are generally reported with chemotherapy and radiation and that median life expectancy is very low. They recommended considering curative high-dose radiation as a reasonable treatment option for patients with unresectable or recurrent primary pericardial mesotheliomas.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Mesothelioma, Dyspnea, Pericardium, Chemotherapy.

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