Written By: Camryn Keeble

Pleural Mesothelioma Radiation Therapy

Radiation therapy is a noninvasive pleural mesothelioma treatment option. It sends energy beams into the chest cavity with the goal of damaging cancer cells. Pleural mesothelioma radiation is most effective when combined with surgery or chemotherapy. This type of therapy can also reduce discomfort caused by tumors pressing against the chest or lungs.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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Important Facts About Pleural Mesothelioma Radiation Therapy

  • Pleural mesothelioma radiation therapy is painless for the patient and can be compared to receiving an X-ray imaging scan.
  • There are three types of radiotherapy for pleural mesothelioma: photon; intensity-modulated; and proton beam therapy.
  • Mesothelioma specialists often combine radiation therapy with other treatment options.

What is Pleural Mesothelioma Radiation? 

Pleural mesothelioma radiation, sometimes referred to as mesothelioma radiotherapy, is a noninvasive, painless treatment. It is similar to undergoing an X-ray scan, as it sends high-energy radiation beams into the chest cavity. The difference between the two is that the radiation energy beams are trying to target and destroy mesothelioma tumors whereas X-rays take two-dimensional images of the inside of your body to help diagnose a condition. 

Radiation usually does not immediately kill mesothelioma cells, but it often causes long-term structural damage to the cells. The beams damage the genetics of the mesothelioma cells, preventing the replication and slowing the growth of the cancer. Eventually, the cells can die.

In cases of pleural mesothelioma, radiation oncologists use radiotherapy to target diseased tissue in the chest cavity and the pleura, which is the thin lining surrounding the lungs and is where pleural mesothelioma forms. Radiation oncologists are cautious not to damage healthy lung tissue. Oncologists often perform “hemithoracic radiation,” which focuses on one side of the chest. Doctors place shields over the patient’s heart and abdomen to protect them from the radiation.

Multimodal Treatment with Pleural Mesothelioma Radiation

It is common for mesothelioma specialists to recommend radiation in combination with other treatments. This is called multimodal treatment. 

For pleural mesothelioma, there are two surgery options often recommended to be paired with radiation: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). 

Extrapleural pneumonectomy (EPP) is considered an aggressive surgery for pleural mesothelioma, as it involves removing one of the lungs.

Pleurectomy with decortication (P/D) is often referred to as the lung-sparing surgery for pleural mesothelioma. It is an invasive treatment option as the surgeon will remove the pleura and attempt to strip tumors off of the exterior of the lung.

In cases of pleural mesothelioma, doctors may recommend administering radiation therapy before, during or after surgery. These methods to using pleural mesothelioma radiation are called:

  • Neoadjuvant radiation – This refers to using radiation therapy before pleural mesothelioma surgery, also known as the SMART approach. It aims to shrink mesothelioma tumors before surgery, making surgical removal easier.
  • Intraoperative radiation – This refers to using radiation therapy during surgery. It is an attempt to target tumors without damaging healthy tissue or nearby organs by gaining direct access to the diseased area.
  • Adjuvant radiation – This refers to using radiation after surgery to target any remaining tumors not removed during the operation.

Types of Radiation Therapy for Pleural Mesothelioma 

There are three types of radiotherapy for pleural mesothelioma treatment: photon radiation therapy, intensity-modulated radiation therapy (IMRT), and proton beam radiation therapy. 

Photon Radiation Icon

Photon Radiation

Photon radiation for pleural mesothelioma, also known as external beam radiation, sends X-ray radiation beams to the chest cavity. The radiation beams travel through the skin and into the pleura, sometimes scattering radiation particles that can damage healthy tissue. Photon radiation therapy sessions can last up to 30 minutes.

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Intensity-Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) for pleural mesothelioma sends radiation beams to the chest cavity. The beams are programmed to conform to the shape of the tumors, limiting damage to healthy tissue. If administered after EPP surgery, there is typically minimal damage to healthy tissue and the remaining lung. IMRT sessions typically last between 15-30 minutes.

Proton Beam Radiation Icon

Proton Beam Radiation

Proton beam radiation therapy is a newer and more focused type of radiation for pleural mesothelioma treatment. It’s mostly available at proton radiation centers rather than general cancer centers. This type of radiation limits the scattering of radiation particles and damage to healthy tissue. Proton beam radiation therapy sessions last approximately 15 minutes.

Side Effects of Pleural Mesothelioma Radiation

Although radiotherapy for pleural mesothelioma is a rather painless treatment method, it can cause some side effects. The most common side effect of radiation is damage to healthy lung tissue, which can lead to pulmonary fibrosis, also known as lung scarring.  

Other side effects of pleural mesothelioma radiation may include:

  • Fatigue
  • Coughing
  • Shortness of breath
  • Nausea
  • Skin irritation (redness, blisters, dryness, itching or peeling)

Pleural Mesothelioma Radiation Survival  

Administering radiation therapy before or after pleural mesothelioma surgery significantly improves the patient’s life expectancy. Several studies from top mesothelioma cancer centers have proven the benefits of radiation. 

According to one study, pleural mesothelioma radiation combined with P/D surgery had a 2-year survival rate of 58%.

Radiation with P/D Chart

Radiation combined with EPP surgery also showed positive survival rates in a mesothelioma study. Patients with biphasic and sarcomatoid mesothelioma cell types had a median survival of 24.4 months. Patients with the epithelioid mesothelioma cell type had an even better response: a 3-year survival rate over 70%.

Radiation with EPP Chart

Radiation combined with EPP surgery also showed positive survival rates in a mesothelioma study. Patients with biphasic and sarcomatoid mesothelioma cell types had a median survival of 24.4 months.

Radiation with EPP Chart

Patients with the epithelioid mesothelioma cell type had an even better response: a 3-year survival rate over 70%.

Frequently Asked Questions About Pleural Mesothelioma Radiation

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Can Radiotherapy Help Treat Pleural Mesothelioma?

Radiotherapy can help treat mesothelioma and improve survival. The best results are typically seen when mesothelioma specialists pair radiation therapy with another treatment method, such as surgery or chemotherapy. According to a study from Michigan Medicine, radiation before pleural mesothelioma surgery led to a median survival of more than four years in a small group of patients.

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What are the Different Types of Radiation Therapy for Pleural Mesothelioma?

There are three types of radiation therapies for pleural mesothelioma patients: photon, intensity-modulated, and proton beam therapy. Photon radiation is the traditional X-ray type, known as external beam radiotherapy. Intensity-modulated radiation therapy is a more focused form, as the beam conforms to the shape of the tumor. Proton beam radiation is the latest evolution of radiation treatment, using proton beams instead of X-rays to limit damage to healthy tissue.

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What are the Common Side Effects of Radiotherapy for Pleural Mesothelioma?

Damage to healthy lung tissue is the most common side effect of pleural mesothelioma radiation. Lung tissue damage can lead to further health problems, such as pulmonary fibrosis or lung scarring. Other side effects may include fatigue, skin irritation, blisters, shortness of breath, nausea, dry skin, itchy skin, peeling skin, and coughing.

Sources & Author

  1. Radiation Therapy to Treat Cancer. National Cancer Institute. Retrieved from: https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy. Accessed: 07/12/2021.
  2. Radiation Therapy Process. Stony Brook Cancer Center. Retrieved from: https://cancer.stonybrookmedicine.edu/RadiationTherapyProcess. Accessed: 07/12/2021.
  3. The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation. Journal of Thoracic Oncology. Retrieved from: https://www.jto.org/article/S1556-0864(19)30380-6/fulltext. Accessed: 07/14/2021.
  4. Radical Hemithoracic Radiotherapy Versus Palliative Radiotherapy in Non-metastatic Malignant Pleural Mesothelioma: Results from a Phase 3 Randomized Clinical Trial. International Journal of Radiation Oncology. Retrieved from: https://www.redjournal.org/article/S0360-3016(20)34597-1/fulltext. Accessed: 07/14/2021.
  5. Radiation Therapy for Mesothelioma. Memorial Sloan Kettering Cancer Center. Retrieved from: https://www.mskcc.org/cancer-care/types/mesothelioma/treatment/radiation-therapy. Accessed: 07/14/2021.
  6. Assessment of Proton Beam Therapy Use Among Patients With Newly Diagnosed Cancer in the US, 2004-2018. JAMA Network. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791568. Accessed: 05/06/2022.
Camryn Keeble image

About the Writer, Camryn Keeble

Camryn Keeble is the senior content writer and editor for Mesothelioma Guide. She creates informative content to educate mesothelioma patients and their loved ones on news, treatments and more. She also works diligently to raise awareness of the dangers of asbestos exposure and the effects of mesothelioma.