Successful treatment of a patient with oligometastatic mesothelioma to the brain

Our plain-English summary of Successful treatment of a patient with oligometastatic mesothelioma to the brain, by S.S. Li, D.A. Steimer, S. Coy, et al (JTCVS Techniques, 2020).

The study

• Authors: S.S. Li, D.A. Steimer, S. Coy, R. Bueno
• Journal: JTCVS Techniques
• Published: 2020;3:358-360
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This case report from a thoracic surgery program at Brigham and Women's Hospital in Boston described one patient. A 48-year-old man with a history of asbestos exposure was diagnosed with epithelioid mesothelioma of the right pleura. The article gives no details of the exposure. Scans showed disease confined to the right side of the chest. He had radical pleurectomy and decortication with heated chemotherapy during surgery, then 4 cycles of chemotherapy (cisplatin and pemetrexed). Two years later he developed speech problems, and imaging showed a single lesion in the left frontal lobe of the brain, with no disease elsewhere. The lesion was removed and confirmed as epithelioid mesothelioma, and the site was then treated with stereotactic radiation (25 Gy). At the time of reporting he was 5.5 years past pleurectomy and 3.5 years past brain treatment, with no evidence of recurrence. The authors said he was the first of more than 150 long-term survivors at their program to develop a brain metastasis. They proposed offering resection and/or radiation to selected patients with isolated recurrences. As a case report, it describes one person's course.

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
• Who was studied: One 48-year-old man with right pleural epithelioid mesothelioma, treated at the authors' program in Boston (Brigham and Women's Hospital)
• Exposure: A history of asbestos exposure. No fiber type, job, product or dose is given.
• Main results:
  • Pleural biopsy diagnosed epithelioid type mesothelioma, and staging showed disease localized to the right hemithorax.
  • After radical pleurectomy, decortication and intraoperative heated chemotherapy (cisplatin and gemcitabine), final pathologic stage was pT3N0. He then completed 4 cycles of adjuvant cisplatin and pemetrexed.
  • Two years after pleurectomy, imaging showed a single lesion in the left frontal lobe of the brain. Restaging found no other sites of disease.
  • Pathology of the removed brain mass confirmed epithelioid mesothelioma, with no change to biphasic or sarcomatoid subtype.
  • Because of close margins, he received stereotactic radiation (25 Gy) to the surgical bed one month after resection.
  • At 5.5 years after pleurectomy and 3.5 years after treatment of the brain lesion, he had no evidence of disease recurrence at the time of reporting.
  • The authors reported that this patient is 1 of more than 150 long-term (more than 5 years) survivors at their program, and the first of them to develop an intracranial metastasis.
• The authors' conclusion: The authors proposed that isolated recurrences (brain, adrenal, liver) be discussed in multidisciplinary conference, and that patients at least 1 year after pleurectomy with no other sites of disease be offered resection and/or radiation. They did not advise routine brain imaging for surveillance. They recommended a low threshold for brain CT or MRI in mesothelioma patients with new neurologic complaints. They anticipated more distant recurrences as local control of disease improves.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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