Brief Report: Multimodality Therapy in Patients with Primary Pericardial Mesothelioma

Journal of Thoracic Oncology 2022 September 5 [Link]

Michael Offin, Dilanka De Silva, Jennifer L Sauter, Jacklynn V Egger, Ellen Yorke, Prasad S Adusumilli, Andreas Rimner, Valerie W Rusch, Marjorie G Zauderer


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

Methods: 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 through February 2022. Clinicopathologic features and treatment outcomes were annotated. Overall survival (OS) was defined from the date of pathologic diagnosis.

Results: The median age at diagnosis of the 12 patients identified with PPM was 51 (range 21-71) years old. Most patients were female (n=8; 67%), 75% of samples were epithelioid (n=9), and 25% were non-epithelioid (2 sarcomatoid and 1 biphasic). Most (92%, 11/12) cases demonstrated 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 vs. 8.2 months for those who did not.

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