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Rare Form of Mesothelioma Appears after Multimodal Treatment


Advanced mesothelioma treatment approaches like multimodal therapy may not only prolong survival in some patients; they may also cause fundamental changes in the way the disease presents itself.

Pleural mesothelioma is a malignancy of the thin lining that encases the lungs. It is caused by exposure to asbestos. Typically, the prognosis is poor. But a multinational study in the Journal of Thoracic Oncology finds that more efficient chemotherapy protocols and aggressive management strategies are resulting in more longer-living patients. The researchers single out the powerful trimodal combination of induction chemotherapy, extrapleural pneumonectomy surgery, and adjuvant high-dose hemithoracic radiation for its impact on survival.

Although this therapy combination may hold mesothelioma at bay in some cases, it usually returns eventually. The new study finds that, when it does, it may look very different. Researchers from the Mayo Clinic and a team of French doctors report that, in patients whose mesothelioma has been treated by trimodal therapy, the disease may present differently the second time around. They write, “New presentations of the disease are appearing with new diagnostic and therapeutic challenges.”

To illustrate their point, the authors detail two cases of treated mesothelioma in which the disease returned in the remaining lung in a rare miliary form. Literally, ‘miliary’ means resembling millet seeds. Instead of spreading out across the mesothelium in a sheet as mesothelioma usually does, the ‘new’ type of mesothelioma showed up in the form of tiny seed-like metastases in multiple locations in the remaining lung.

The good news is that this miliary mesothelioma did not develop until 36 and 41 months after the original multimodal treatments. The bad news is that doctors have even less experience treating mesothelioma in this form, potentially making it an even greater treatment challenge than the original disease. The study’s authors discuss their diagnostic and therapeutic approach to this new challenge which, ironically, may become more common as mesothelioma treatments improve.


Purek, L et al, “Miliary Mesothelioma: A New Clinical and Radiological Presentation in Mesothelioma Patients with Prolonger Survival after Trimodality Therapy”, October 6, 2011, Journal of Thoracic Oncology, Volune 6, Issue 10, pp 1753-1756.

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