Written By: Devin Golden

Types of Mesothelioma Radiation

There are different types of mesothelioma radiation therapy. The newest types are more effective at killing cancer cells while avoiding damage to healthy tissue. Visiting a cancer center or specialized radiation center will get you or your loved one the best radiation therapy type.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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Important Facts About the Types of Mesothelioma Radiation

  • There are three types of mesothelioma radiation: photon, proton and intensity-modulated. Most cancer centers use intensity-modulated, which is more targeted than photon beams.
  • Each type is limited just to pleural mesothelioma, as radiation isn’t an accepted therapy for peritoneal mesothelioma.
  • Radiation is often used along with other therapies, most notably surgery. Radiation can be administered either before (neoadjuvant), during (intraoperative) or after (adjuvant) surgery.

What Are the Types of Radiation for Mesothelioma?

The types of radiation include photon radiation therapy, intensity-modulated radiation therapy (IMRT), and proton radiation therapy. These three constitute the options mesothelioma patients will have when electing which method to receive.

Photon Radiation

Photon radiation, also called external beam radiation, sends a radiation beam at the tumor site. For mesothelioma, this is most often the chest. The beam travels through the chest cavity and into the pleura.

Photon beams are used in X-rays for imaging scans, but radiation requires a higher dose. Photo beams can reach tumors deep in the thorax, but they often scatter bits of radiation and damage surrounding healthy tissue. Photon beams also go through tumors and can damage healthy tissue on the other side.

Photon radiation lasts up to 30 minutes and usually occurs five days a week. Patients may receive photon radiation for 1-2 months.


IMRT, which stands for intensity-modulated radiation therapy, sends targeted beams at the tumor site. It limits damage to healthy tissue and the remaining lung if used after extrapleural pneumonectomy surgery.

In one study, only up to 20% of patients had pneumonitis (lung tissue scarring) after lung-removal surgery. This is an improvement from photon radiation.

IMRT usually lasts around 15-30 minutes and usually occurs five days a week. An entire regimen may last up to two months.

Proton Beam Radiation

Proton radiation therapy is the newest type used for mesothelioma. It’s usually available at proton radiation centers rather than general cancer centers.

Proton radiation limits the scattering of radiation beams and damage to healthy tissue. The beams also stop at the tumor site rather than passing through to healthy tissue on the other side. In one study, proton radiation caused pneumonitis after EPP in only 7% of patients.

The sessions last around 15 minutes and occur a few times per week. According to a proton radiation specialist at the New York Proton Center, programs for patients can last 2-6 weeks.

When to Use Radiation for Mesothelioma

Doctors and cancer centers have varying views on when to use radiation in multimodal treatment for mesothelioma:

  • The traditional thought is to use radiation after surgery, which is called adjuvant radiation treatment.
  • Some may use it during surgery, which is called intraoperative radiation therapy (IORT).
  • The newest approach is using radiation before surgery, which is called neoadjuvant radiation treatment.

Neoadjuvant Radiation

Neoadjuvant radiation for mesothelioma mostly refers to using the therapy prior to surgery. Another term for this is SMART for mesothelioma, an acronym for “surgery for mesothelioma after radiation therapy.” It started at Princess Margaret Cancer Center in Toronto and now is the featured program of Michigan Medicine cancer center.

Neoadjuvant radiation shrinks the size of tumors and makes removal during surgery easier. This approach has median survival times of 2-5 years, with variances depending on the cancer center, surgeon and patient selection.

Intraoperative Radiation

Intraoperative radiation targets tumors either during surgery or immediately following surgery, before the operation concludes. The intent is to target tumors without needing to pass through skin or other healthy tissue.

One of the side effects of radiation is damage to healthy tissue. IORT is an attempt to sidestep this side effect.


Brachytherapy is a type of intraoperative radiation therapy for mesothelioma. Doctors implant a small radioactive pellet into the tumor. This pellet provides a continuous dose of radiation after surgery.

Temporary brachytherapy implants are removed minutes after surgery ends. Permanent implants work for up to 10 months.

Adjuvant Radiation

Adjuvant radiation is the oldest and most common approach to multimodal mesothelioma therapy. The intent is to target any tumors not removed during surgery.

Taking out all mesothelioma tumors is difficult through surgery. Most patients still have microscopic tumors or ones too close to organs for safe removal. Adjuvant radiation can either kill these tumors or contain them to their current size and location.

Sources & Author

  1. External Beam Radiation Therapy for Cancer. National Cancer Institute. Retrieved from: https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/external-beam. Accessed: 05/26/2021.
  2. Brachytherapy Frequently Asked Questions. American Brachytherapy Society. Retrieved from: https://www.americanbrachytherapy.org/resources/for-patients/brachytherapy-frequently-asked-questions/. Accessed: 05/26/2021.
  3. Radiotherapy doubles survival for patients with mesothelioma. European Society for Radiotherapy and Oncology. Retrieved from: https://www.sciencedaily.com/releases/2019/04/190429125437.htm#:~:text=Summary%3A,affected%20side%20of%20the%20trunk. Accessed: 05/26/2021.
Devin Golden

About the Writer, Devin Golden

Devin Golden is the senior content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.