Multimodality Therapy in Patients With Primary Pericardial Mesothelioma

Published:September 05, 2022DOI:



      Primary pericardial mesothelioma (PPM) has no accepted standard-of-care treatment options with management and outcomes often extrapolated from diffuse pleural mesothelioma. Disease-specific research is needed to better define PPM. We report our institutional experience with PPM highlighting the potential role for multimodality therapy.


      Patients with PPM diagnosed by a multidisciplinary team of medical oncologists, thoracic surgeons, thoracic pathologists, and radiologists between January 2011 and January 2022 were followed to February 2022. Clinicopathologic features and treatment outcomes were annotated. Overall survival (OS) was defined from the date of pathologic diagnosis.


      The median age at diagnosis of the 12 patients identified with having PPM was 51 (range: 21–71) years old. Most patients were of female sex (n = 8; 67%), 75% of the samples were epithelioid (n = 9), and 25% were nonepithelioid (two sarcomatoid and one biphasic). Most cases (92%, 11 of 12) had expression of at least two mesothelial markers on immunohistochemistry. The median OS of the cohort was 25.9 months. Five patients had an OS greater than 12 months; four of whom received pericardial radiation. Three of the patients who received radiation did so as part of a trimodality approach (surgical resection, adjuvant chemotherapy, and radiation); the OS for patients who received trimodality therapy was 70.3 months versus 8.2 months for those who did not.


      PPM represents a distinct disease with no universally accepted treatment options. Our findings suggest that trimodality therapy may improve outcomes in selected patients with PPM.


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      • Pericardial Mesothelioma, a Disease for Brave Hearts
        Journal of Thoracic OncologyVol. 17Issue 12
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          In the past decade, there has been a steady, although slow, improvement in the treatment of mesothelioma, the rare tumor of the mesothelial surfaces caused by asbestos exposure. The advances were mostly driven by research in the field of pleural mesothelioma biology and treatment and, at a lesser extent, peritoneal mesothelioma,1,2 which is the second most frequent. Pericardial mesothelioma is an exceedingly rare entity. Its correlation with asbestos exposure is controversial; indeed, on one hand, some authors exclude any correlation,3 and, on the other hand, others report significant association with asbestos exposure,4 thus leaving the real pathogenic process uncertain.
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