Malignant mesothelioma and central nervous system metastases. Report of two cases, pooled analysis, and systematic review.

RATIONALE

The incidence and patterns of metastatic disease to the central nervous system (CNS) from malignant mesothelioma are not well characterized.

OBJECTIVES

We describe the treatment of two cases of pleural mesothelioma with CNS metastases. We also report the results of a systematic review with pooled data analysis of CNS metastases from malignant mesothelioma.

METHODS

PubMed, Scopus, EMBASE, and Web of Science were searched to identify relevant published studies. Inclusion criteria for the pooled analysis were any clinical or autopsy study in which patients had a confirmed histological diagnosis of malignant mesothelioma and CNS metastasis was identified by autopsy, clinical pathological specimen, or compelling radiographic imaging. Case reports were excluded from the pooled analysis but were incorporated into the discussion. One hundred forty-one potentially relevant references were identified. Seven studies including 655 patients were included in the pooled analysis. Ninety-seven additional cases were identified and incorporated into the discussion. A systematic review of the literature is provided with pooled data analysis.

MEASUREMENTS AND MAIN RESULTS

CNS involvement of malignant mesothelioma may occur by hematogenous spread or by local extension. Some cases may represent tumor dedifferentiation to a more aggressive histologic subtype. Surgery or stereotactic therapies may play a role for select patients; however, rapid recurrence has been reported.

CONCLUSIONS

The prognostic significance of CNS disease is not well characterized. Clinicians should consider and identify CNS involvement in patients with new or evolving neurologic symptoms because early identification may allow for palliative intervention.