Radiation is one of the main therapies for malignant mesothelioma. It is primarily for cases of pleural mesothelioma and best before or after aggressive surgery.
Written by Karen Ritter, RN BSN
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Important Facts About Mesothelioma Radiation
- Radiation sends energy beams into the chest cavity to kill cancer cells.
- Radiation is painless for the patient. It’s similar to receiving an X-ray imaging scan.
- Most doctors prefer using radiation after surgery and other therapies, such as chemotherapy and immunotherapy.
- Radiation can reduce tumor size before surgery or kill lingering cells not removed during an operation.
- Some doctors suggest radiation as a palliative treatment. It can relieve pain by shrinking tumors, softening the pressure against the chest.
What Is Mesothelioma Radiation?
Radiation is a noninvasive cancer therapy. It’s one of the few approved treatment options for mesothelioma. Radiation therapy doesn’t kill the cancer cells immediately, but it causes long-term structural damage to the cells.
Radiation machines deliver high-energy beams, such as X-rays or protons, to target malignant tumors. These beams harm the genetics of mesothelioma cells, which prevents replication and slows the growth of cancer. The cells eventually die without replicating, which is a therapeutic way to treat cancers like mesothelioma.
What Is the Process for Mesothelioma Radiotherapy?
Radiation oncologists are doctors licensed to deliver radiation treatment to patients. They map out the region in the body to target with the machine. This is called the “simulation” process.
Once simulation is complete, the radiation oncologist delivers the treatment. They may use immobilization devices to keep you from moving during the treatment.
Patients lay flat on a table under the radiation machine. The radiation oncologist or other team members may use lead shields to block the rays from hitting other parts of the body.
The process may change based on the type of radiation used.
How Long Does Radiation Last?
Radiation therapy treatment usually takes around 10 minutes. However, the entire stay in the medical facility is usually around 30 minutes.
Preparation can take 10-15 minutes. Doctors may keep patients after treatment ends to watch for side effects, such as nausea and fatigue.
Patients usually receive radiation treatment five days a week. The length of radiation treatment can be a few weeks to a couple months. Your oncologist will determine the best length for your diagnosis.
The length of each session, frequency of treatment and duration of treatment changes for each type of radiation. Different cancer centers may use unique protocols.
Memorial Sloan Kettering Cancer Center, a leading institution for mesothelioma treatment, begins radiation therapy 4-6 weeks after surgery. Patients receive the therapy for 5-6 weeks.
Different Multimodalities for Radiation
Multimodal therapy for malignant mesothelioma involves using different treatment methods together. Radiation is a key element to multimodality for this rare disease.
Doctors use radiation as one part of a lengthy treatment process. The plan usually begins with mesothelioma surgery. Doctors also team radiation with:
How to Get Radiation for Mesothelioma
If you want to learn more about radiation or how to start radiotherapy for mesothelioma, follow these three steps:
Meet with a specialist at a mesothelioma cancer center. They’ll provide their expert insight into your treatment options and explain the benefits and concerns regarding radiation therapy. They may work directly with a radiation oncologist or can refer you to one.
Learn the different types of radiation therapy. The traditional type is called photon radiation, but other methods have emerged in the 21st century. Intraoperative radiotherapy may be an option if you’re eligible for surgery.
Meet with a radiation oncologist. Learn your schedule for treatment, including how many sessions you’ll have and the time between each one. You should also review the possible side effects.
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Including Cell Type
Radiation for Pleural Mesothelioma
Radiation for pleural mesothelioma sends high-energy beams into the chest cavity. Doctors use this treatment for diseased tissue in the lung cavity and the pleura (the lining between the lungs and chest wall). Radiation oncologists must be cautious of damaging healthy lung tissue.
Radiation oncologists usually focus on one side of the chest for pleural mesothelioma. This is called “hemithoracic radiation” treatment. Doctors place blocks over the heart and abdomen to protect against radiation spray.
Most pleural mesothelioma specialists recommend hemithoracic radiation with extrapleural pneumonectomy (EPP), a surgery for pleural mesothelioma. This radical surgery removes the affected lung. Radiation specialists deliver the treatment into the lung cavity before, during or after EPP surgery.
Doctors also use radiation before, during or after pleurectomy with decortication (P/D), a lung-sparing surgery. Since both lungs remain, doctors must be cautious about harming healthy lung tissue.
Recommended Dosage for Pleural Mesothelioma
Each hospital or radiation treatment center may follow different protocols for administering radiation. The report in the Journal of Thoracic Oncology offers guidelines for pleural mesothelioma radiation treatment.
The report was a collaboration of the National Cancer Institute, Mesothelioma Applied Research Foundation and International Association for the Study of Lung Cancer. Their suggestions for mesothelioma radiation dosage are:
- Hemithoracic radiation after EPP — 45‑60 Gy (grays), given in 1.8‑2.0 Gy fractions
- Hemithoracic radiation before EPP — 25‑30 Gy, given in 5‑6 Gy fractions
- Hemithoracic radiation with P/D — 50.4 Gy, given in 1.8 Gy fractions
When used with EPP, radiation dosage is lower towards the remaining lung. Since there’s only one lung remaining, it must be protected from pneumonitis (lung tissue scarring and inflammation). A report in the Journal of Thoracic Oncology states lowering the radiation dose has dropped pneumonitis rates under 10%.
Radiation for Peritoneal Mesothelioma
Radiation is not an accepted therapy for peritoneal mesothelioma. Unlike pleural mesothelioma, peritoneal mesothelioma forms near multiple organs. The risk of radiation damage to these organs outweighs the benefits.
Doctors may recommend palliative radiation for symptom management. These treatments are delivered at low dosages.
Mesothelioma Survival Rates From Radiation
Radiation before or after surgery significantly improves life expectancy for mesothelioma patients. Multiple studies from leading cancer centers showcase the benefits of this therapy.
In one study, hemithoracic radiation with P/D had a two-year survival rate of 58%. Only nine of the 55 patients experienced grade 2 or worse pneumonitis.
Radiation before EPP also has impressive mesothelioma survival rates. A median survival of 24.4 months included biphasic and sarcomatoid cell types. Epithelioid cell cases have even better survival, including a 3-year survival rate over 70%.
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Types of Radiation for Mesothelioma
There are a few different types of radiation for malignant mesothelioma. They differ in the size (radius) and intensity of the energy beams. The three main types are:
Proton beam radiation — This is also called external beam radiation. It’s the original type of radiation treatment. The radiation machine sends X‑ray beams into the patient’s body to kill cancer cells. The one concern is radiation spray hitting healthy tissue outside the target area. Most cancer centers no longer use proton beam radiation.
Intensity‑modulated radiation therapy (IMRT) — This type uses a targeted beam (smaller radius) and requires a lower dose than proton beams. Most cancer centers now use IMRT for mesothelioma treatment.
Proton beam radiation — This is the newest type of radiation therapy. Proton beams are the most targeted method, limiting the damage to healthy tissue. It also requires the lowest dosage for effective treatment. This type of radiation usually requires less time in the facility, fewer sessions per week and fewer cycles.
When to Use Radiation
There are varying beliefs and opinions about when to use radiation for mesothelioma. Since surgery is the key treatment for beating cancer, specialists build a therapy plan around the operation.
The three different ways to use radiation are:
Before surgery (neoadjuvant radiation) — Doctors use radiation to contain or shrink tumors before surgery. This approach is called “SMART”, which stands for surgery for mesothelioma after radiation therapy. It is growing in popularity after impressive survival rates.
During surgery (intraoperative radiation) — Doctors have direct access to the chest cavity and administer energy beams before closing the incision. This method avoids damage to skin tissue and healthy organ tissue.
After surgery (adjuvant radiation) — Doctors use radiation after surgery to diminish the chance of recurrence. This method kills cancer cells not removed during surgery. This approach is called “IMPRINT”, which stands for intensity-modulated pleural radiation therapy.
Palliative Radiation for Mesothelioma
Radiation is also a palliative therapy for people with late‑stage mesothelioma cancer. Doctors target tumors with low‑strength beams to relieve pressure.
Tumors build up in the pleural cavity and on the surface of the lungs. Taking up space in the pleural cavity means less room for the lungs to expand. This creates chest pain and fluid buildup. Tumors along the lungs can also cause side effects, such as a persistent cough, hoarseness, appetite loss and shortness of breath.
Palliative radiation can decrease pleural mesothelioma symptoms. Pain relief may not begin until 10 days after radiation therapy starts. There are a few recommended options for palliative mesothelioma radiation dosage, according to the National Cancer Institute, International Association for the Study of Lung Cancer and Mesothelioma Applied Research Foundation:
- 30‑39 Gy, given in 3 Gy fractions
- 20‑40 Gy, given in 4 Gy fractions
Common Questions About Radiation for Mesothelioma
Are there different types of radiation for mesothelioma?
There are three types of radiation for mesothelioma: photon, intensity‑modulated and proton therapy. Photon radiation is the traditional X‑ray type, also known as external beam radiotherapy. Intensity‑modulated radiation therapy conforms the beam to the shape of the tumor. Proton radiation uses proton beams rather than X‑rays, which reduces damage to healthy tissue.
What are the common side effects of mesothelioma radiation?
Damage to healthy lung tissue is the most common side effect of mesothelioma radiation. This damage can cause scarring, which is a medical condition called pulmonary fibrosis. Other side effects include:
- Skin problems (itchiness, dryness or peeling)
- Shortness of breath
Does radiation improve mesothelioma survival?
Radiation can improve mesothelioma survival and offers the greatest benefit when paired with other therapies. The combination of surgery and radiation can lead to post‑treatment survival of 30 months. In one study conducted at Michigan Medicine, radiation before mesothelioma surgery led to a median survival of more than four years.
Where can I get radiation for my mesothelioma?
Most cancer centers offer radiation as a treatment option. If the center has a dedicated team for mesothelioma cases, they likely have state‑of‑the‑art radiotherapy equipment and an on‑staff radiation oncologist. Our Doctor Match service can help you find a hospital offering radiation as part of its treatment protocol.
Sources & Author
- Radiation Therapy to Treat Cancer. National Cancer Institute. Retrieved from: https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy. Accessed: 07/12/2021.
- Radiation Therapy Process. Stony Brook Cancer Center. Retrieved from: https://cancer.stonybrookmedicine.edu/RadiationTherapyProcess. Accessed: 07/12/2021.
- 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.
- 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.
- 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.