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Pleural Mesothelioma and Brain Metastasis

Published: November 11, 2022

When people are diagnosed with mesothelioma, it is common for the disease to spread. This occurs in around 60 percent of people, but it does not usually spread to the brain. Researchers in Great Britain believe doctors should be focusing on cerebral metastasis in mesothelioma patients in addition to other areas of the body because there are patients that could be helped. Doctors want to research the metastatic potential of mesothelioma, which is usually only found in autopsy findings. A case study was published in the Cureus Journal of Medicine on October 16 examining a mesothelioma patient with brain metastasis at University Hospitals of North Midlands in the United Kingdom.

The female patient was diagnosed with intracranial metastasis as a secondary diagnosis to pleural mesothelioma. Her body did not respond to aggressive treatment because of cancer progression, intolerance to chemotherapy, and the multiplicity of the spread to the brain. She was given palliative radiation therapy and died after eight months. The primary cause of pleural mesothelioma is asbestos, which is usually inhaled and becomes lodged in the lungs and mesothelial tissue surrounding the lungs. It is usually rare to find brain metastasis with pleural mesothelioma because the disease has a short survival time.

The study found that the most common places for cancer spread are the opposite lung, liver, adrenal glands, kidneys, and bones. Mesothelioma typically spreads to these areas through lymph nodes. In different studies, brain metastasis is usually found in around two to five percent of cases, typically after death. When patients have brain metastasis, they usually do not receive therapy or only receive therapy that alleviates symptoms (palliative therapy). The study shows that there could be options for treating brain metastasis including whole brain radiation, stereotactic radiotherapy, resection, and systemic corticosteroids. The cancer does not usually respond well to these treatments, but there could be other options for treating brain metastasis including immunotherapy.

Another case study was performed at Drexel University in Philadelphia on a 72-year-old male with pleural mesothelioma. Doctors found the metastasis early and treated it more aggressively. He was given a left frontal craniotomy for resection, which helped eliminate symptoms. After one month, he had to undergo a stereotactic radiosurgery and a second resection due to new lesions being found. This shows that even with a multimodal approach to treatment, more lesions can occur that change how doctors need to approach an individual patient.

A different case report in Seoul, South Korea found that a brain metastasis patient needed radiosurgery very soon after it was found. The report also noticed that there were 12 patients that lived for six months or more after being diagnosed with a brain metastasis. Almost all the cases utilized aggressive interventions like intracranial mass removal or whole brain radiotherapy. The report found that a multimodal approach can expand life expectancy and provide relief of symptoms. It was concluded that doctors should use aggressive treatments after a malignant pleural mesothelioma brain metastasis is found if the patient has a stable primary lung lesion.

Abhijith Bathini et al., “Cerebral metastases of malignant mesothelioma” Journal of Surgical Case Reports (February 2022). [Link]
Cleofina Furtado et al., “Haemorrhagic Brain Metastasis From Malignant Pleural Mesothelioma: A Rare Case” Cureus (October 16, 2022). [Link]
Myoung Soo Kim et al., “Brain metastasis of a malignant pleural mesothelioma: A case report and review of the literature” Interdisciplinary Neurosurgery (March 2021). [Link]
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