1. Malignant Pleural Mesothelioma Post- Irradiation Treatment for Hodgkin’s Lymphoma Thea Price MD, R.V. Sooppan MD, Michael Walker MD Department of Thoracic Surgery Thomas Jefferson University Hospital Eastern Cardiothoracic Surgical Society Annual Meeting October 23-36, 2013

2. Introduction: Malignant Pleural Mesothelioma (MPM) Long latency period (10-40 years) 85% from environmental exposure (asbestos) 15% arise without environmental exposure 2 nd primary malignancies 30-fold increase risk after irradiation (XRT) treatment for Hodgkin Lymphoma (HL) Asbestos

3. Patient Data Patient Age of HL Dx Age of MPM Dx XRTXRT Chemo Asbestos exposure Type MPM 1) Female1765+--Epithelioid 2) Male1653+--Epithelioid

4. Radiology Patient 2: PET Patient 1 : PET

5. Conclusions Extended Field Radiation utilized in the 1970s and 1980s, especially in adolescents, significantly raises the risk of second primary malignancy ≥ 30 years later 77% of deaths >10 from HL related to longterm effects of therapy* Often widespread invasion at diagnosis Natural history of death within 4-12 months of diagnosis Vitally important to recognize this risk in HL patients presenting with respiratory symptoms or chest pain Acknowledgements Dr. Michael Walker, MD, Thoracic Surgery Department, Main line Health, Pennsylvania Jefferson University Hospitals, Philadelphia, Pennsylvania Yung L, et al. Long term outcome in adolescents with Hodgkin's lymphoma: poor results using regimens designed for adults. Leuk Lymphoma. 2004 Aug;45(8): 1579-85.