PURPOSE: Asbestos exposure is the major known risk factor for mesothelioma, but several case reports have suggested a link between radiation therapy and subsequent development of malignant mesothelioma. This report explores a possible association between radiation therapy for Hodgkin’s disease and mesothelioma. PATIENTS AND METHODS: Four cases of malignant mesothelioma were observed following Hodgkin’s disease at the Mesothelioma Clinic of the Dana-Farber Cancer Institute. A fifth such patient was found after a review of the literature. RESULTS: In all five cases, the mesothelioma arose in the field of prior radiotherapy. No history of asbestos exposure was elicited by careful questioning or by review of chest radiographs. Examination of lung tissue in one patient showed 250 ferruginous bodies per gram of lung tissue, consistent with no significant prior exposure. The mean interval between radiation treatment for Hodgkin’s disease and development of mesothelioma was 15 years, which emphasizes the need for continued follow-up and evaluation of these patients and supports a causal relationship. CONCLUSION: Mesothelioma may need to be added to the list of second malignancies that arise following radiation therapy for Hodgkin’s disease. Further support is given to a causal link between radiation exposure and mesothelioma.

Mesothelioma is a rare form of cancer affecting the mesothelium, which is a membrane that covers and protects most of the internal organs of the body. In most cases, it begins in the pleura (the lining around the lungs) or peritoneum (the lining around the abdomen). The cancer is typically caused by asbestos exposure. A history of asbestos exposure at work is reported in about 70 to 80 percent of all cases of the disease. Standard treatment options include surgery, chemotherapy, and radiation therapy.