Mesothelioma radiation is one of the main treatment options for patients. Radiation therapy is primarily used for cases of malignant pleural mesothelioma. It is best when used with surgery and other therapies.
Written by Karen Ritter, RN BSN
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Important Facts About Mesothelioma Radiation
- Mesothelioma radiation sends energy beams into the chest or abdominal cavity to kill diseased cells, which make up tumors.
- 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 is an important part of multimodal mesothelioma therapy.
- Radiation therapy can help reduce tumor size before surgery or kill lingering cells not removed during an operation. It also can enhance the effects of immunotherapy.
- Some doctors suggest radiation as a palliative treatment. It can relieve pain by shrinking tumors, softening the pressure against the chest or lungs.
What Is Mesothelioma Radiation?
Radiation is a noninvasive treatment option for mesothelioma. Radiation therapy doesn’t kill the cancer cells immediately, but it causes long‑term structural damage to the cells that leads to eventual death without replication.
Radiation therapy machines deliver high‑energy beams, such as X‑rays or protons, to target malignant tumors. These beams harm the genetics of mesothelioma cells. The therapy prevents the cells from replicating, which slows the growth of the cancer. Altering the genetics also increases the chances of cellular death.
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 the simulation is complete, the radiation oncologist delivers the treatment. They may use immobilization devices to keep you from moving during the treatment.
Radiation does not hurt. 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 mesothelioma radiation used.
How Long Does Mesothelioma 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 their own protocols.
Memorial Sloan Kettering Cancer Center, a leading institution for mesothelioma treatment, states on its website that radiation therapy begins 4‑6 weeks after surgery. Patients receive the therapy for 5‑6 weeks.
Different Multimodalities for Mesothelioma 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, often involving other therapies. The most common is mesothelioma surgery. However, doctors also team radiation with:
Surgery, chemotherapy and radiation as a multimodal plan is the traditional approach to treating mesothelioma. More specialists believe radiation and immunotherapy might be a cancer‑killing combination. Radiation can inspire an immune system response, which is then aided by immunotherapy drugs.
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 for mesothelioma. They may work directly with a radiation oncologist or can refer you to one.
Learn the different types of radiotherapy. The traditional type is called photon radiation, but other methods have emerged in the 21st century. Intraoperative radiotherapy may also 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. They’ll also review the side effects you might experience.
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Including Cell Type
Pleural Mesothelioma Radiation
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 where pleural mesothelioma forms). Radiation oncologists must be cautious of injuring healthy lung tissue, which can have lasting effects.
Radiation oncologists usually focus on one side of the chest for pleural mesothelioma radiation. This is called “hemithoracic radiation” treatment. Doctors place blocks over the heart and abdomen to protect from radiation spray.
Most pleural mesothelioma specialists recommend hemithoracic radiation with extrapleural pneumonectomy (EPP), a surgery for pleural mesothelioma. This surgery removes the affected lung. Radiation specialists either deliver the treatment into the lung cavity before, during or after EPP surgery.
Doctors can 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 scarring healthy lung tissue.
Recommended Radiation 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 radiotherapy.
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 to decrease the risk of 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%.
Peritoneal Mesothelioma Radiation
Radiation is not a common therapy for peritoneal mesothelioma. Unlike pleural mesothelioma, peritoneal mesothelioma forms near many organs. The risk of radiation therapy causing damage to these organs outweighs the benefits of the treatment.
Doctors may recommend palliative radiation to aid in symptom management. These treatments are delivered at low dosages to minimize extensive damage.
Survival Rates From Mesothelioma Radiation
Mesothelioma radiation used before or after surgery significantly improves life expectancy for patients. Multiple studies from leading cancer centers showcase the benefits of radiotherapy for this cancer.
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 for all patients included biphasic and sarcomatoid cell types. Epithelioid cell cases have a much longer median survival, including a three‑year survival rate over 70%.
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Types of Radiation for Mesothelioma
There are a few different types of mesothelioma radiation. They differ in the size (radius) of the energy beams and intensity of the 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 is a more advanced type of radiation. It uses a more targeted beam (smaller radius) and requires a lower dose than proton beams for the same cancer‑killing results. 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 a shorter duration for an entire treatment plan.
When to Use Mesothelioma Radiation
There are varying beliefs and opinions about when to use radiation for mesothelioma. Since surgery is the key treatment, specialists build a therapy plan around the operation.
The three different ways to use radiation are:
Before surgery (neoadjuvant radiation) — Doctors rely on radiation to contain or even shrink tumors before surgery. This approach is called “SMART”, which stands for surgery for mesothelioma after radiation therapy.
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 other healthy tissue.
After surgery (adjuvant radiation) — Doctors use radiation after surgery to diminish the chance of disease recurrence. This method aims to kill 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.