New Research Focuses on Mesothelioma Brain Metastasis
Distant metastasis is common with malignant pleural mesothelioma – more than 60% of patients experience it – but rarely is it found around the brain.
A new study by a team of radiation oncologists in Great Britain, however, suggests that physicians should increase their focus on potential cerebral metastasis in mesothelioma patients.
“Patients will continue to live longer as a consequence of newer, more advanced treatments,” the study authors wrote. “It is critical now to recognize mesothelioma’s metastatic potential, particularly cerebral metastasis, which was previously only an autopsy finding.”
The Cureus Journal of Medical Science published the case study on Oct. 16. It centered around a mesothelioma patient with brain metastasis at University Hospitals of North Midlands in the United Kingdom.
Mesothelioma Brain Metastasis Rare
A diagnosis of intracranial metastasis was made secondary to the pleural mesothelioma of the 67-year-old female patient. Her cancer progression, intolerance to chemotherapy and the multiplicity of the brain metastasis led to a rejection of aggressive therapy. She received only palliative radiation therapy and died eight months later.
Pleural mesothelioma, which is typically caused by the inhalation of asbestos fibers, is a rare cancer that starts in the lining surrounding the lungs and chest cavity.
“This is a rare case with distant brain metastases, which encourages further radiological investigation in the presence of symptoms,” the authors wrote. “Intracranial metastases are rare to the brain. This is due to short survival with MPM [malignant pleural mesothelioma].”
The lead author was Dr. Cleofina Furtado, a member of the department of diagnostic and interventional radiology at University Hospitals of North Midlands.
According to the study, the most common pleural mesothelioma metastatic locations are the contralateral (opposite) lung, liver, adrenal glands, kidneys and bones. Mesothelioma tumor cells typically spread through the lymph nodes.
In various retrospective studies, brain metastasis ranges from only 2% to 5% of cases, most of which are discovered after death – until recently.
Most patients with brain metastasis leave their cancer center without therapy, or only a palliative treatment. According to the study, options could include whole-brain radiation, stereotactic radiotherapy, resection or systemic corticosteroids.
However, only in very rare instances have any shown a therapeutic response, leading study authors to suggest additional treatment options, including immunotherapy.
Multimodal Approach Could Extend Life Expectancy
Earlier in 2022, a case study done at Drexel University College of Medicine in Philadelphia detailed the brain metastasis of a 72-year-old male with pleural mesothelioma.
His mesothelioma metastasis was diagnosed early and treated more aggressively. He underwent a left frontal craniotomy for resection, which eliminated symptoms. During a one-month follow-up, though, new lesions were discovered, leading to stereotactic radiosurgery and a second resection.
“Through this case, we aim to highlight that despite employment of a multimodal treatment approach, including surgical excision of symptomatic lesions, further metastatic lesions can occur that complicate treatment plans,” the authors wrote.
Another case report done in 2021 involving mesothelioma brain metastasis highlighted the need for radiosurgery “without delay.” The case was found at the National Medical Center in Seoul, South Korea.
That study also identified 12 reports of patients who survived for six months or longer after mesothelioma brain metastasis was discovered. All but one of the cases involved aggressive interventions such as intracranial mass removal or whole-brain radiotherapy.
“A multimodal approach can provide symptomatic relief and extend life expectancy,” the study from South Korea concluded. “Therefore, clinicians should consider aggressive treatment of a brain metastasis arising from MPM if the patient presents with a stable primary lung lesion.”