Intensity-modulated radiation therapy (IMRT) uses X-rays to kill cancer cells. Many pleural mesothelioma specialists prefer IMRT over simpler forms of radiation therapy, because IMRT hits the cancer from many different angles and with varying levels of intensity.
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IMRT is an advanced type of radiation therapy. Like many types of radiation therapy, it uses a linear accelerator, or linac machine, to aim high-energy X-rays at a tumor site inside a patient’s body.
The difference with IMRT is the linac machine is designed to move around the patient and hit the tumor site from multiple directions. A computer controls exactly how much energy the machine uses at each angle, based on imaging scans taken of the patient’s body.
IMRT Facts
Advanced form of external beam radiation therapy
Safer to administer near vital organs in the chest
May be combined with other cancer treatments
Requires highly specialized equipment and expertise
In treatment for pleural mesothelioma, doses of radiation must be tailored to the exact size and shape of the tumor site. This is because pleural mesothelioma develops near the lungs and heart, which are very sensitive to radiation damage.
IMRT may be safer to use on pleural mesothelioma patients than older methods of radiation therapy. It is one of the most sophisticated forms of external beam radiation therapy.
Radiation therapy for mesothelioma uses energy beams that go into the patient’s body at the site of the cancer, helping to disrupt the cellular regeneration of the cancer, preventing it from growing and spreading.
How Is IMRT Used in Mesothelioma Treatment?
Doctors can use IMRT as a palliative treatment, intended to relieve a patient’s chest pain and improve quality of life. IMRT typically causes only mild side effects on its own, and it is safe to combine with chemotherapy or immunotherapy.
IMRT is also an important part of multimodal treatment to help patients live longer with pleural mesothelioma. In this approach, radiation therapy is usually the last step after surgery and chemotherapy.
Doctors use IMRT to try to kill any cancer cells left behind after surgery. A 2021 study published in The Lancet Oncology concluded extrapleural pneumonectomy after IMRT can be done with good early and long-term results, and other research supports its use in surgery patients who keep both lungs.
IMRT can treat primary mesothelioma tumors and metastases in other parts of the body, according to a 2021 study published in the Journal of Neurosurgery: Case Lessons. Mesothelioma radiation is commonly used to control painful tumors on the chest wall.
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One of the latest advances in external beam radiation is arc-based IMRT. It is designed to improve on the conventional technique known as “step and shoot” or “static fields.” Companies have developed different types of arc-based IMRT technology called helical tomotherapy and volumetric modulated arc therapy.
Arc-based IMRT delivers radiation continuously as the machine rotates in an arc around the patient. It controls its accuracy using a multileaf collimator, which has individual “leaves” that move in and out of the radiation’s path to make the beam the same shape as the tumor site.
Tamron Little
Verified Asbestos.com Survivor
Mesothelioma Survivor Thriving After IMRT
Tamron Little is a 17-year peritoneal mesothelioma survivor who credits early multimodal treatment for her long-term survival. Little underwent surgery, heated chemotherapy and IMRT. “The doctors thought the high-dose radiation had messed up my reproductive organs and I wouldn’t be able to have any more kids,” said Little. But she had 3 more children. “Every time I took another baby to see Dr. Levine, his eyes would just get wider and wider. He’d say, ‘So, this is yours, too? Tamron, you’re amazing. You’re a walking miracle.’”
In helical tomotherapy, the patient lies on a table that slides through a donut-shaped machine. The machine contains a linear accelerator that can revolve all the way around the patient.
A 2024 German study reported that IMRT is safe after surgery on patients with both lungs. In 2023, Turkish researchers reported a 2-year survival rate of 77.9% using surgery, chemotherapy and IMRT.
In 2021, a study in Translational Cancer Research reported that helical tomotherapy targeted tumors better than volumetric modulated arc therapy, but HT’s treatment delivery time was longer.
Volumetric Modulated Arc Therapy (VMAT)
VMAT also uses a linear accelerator that can rotate around a patient. It is much faster than other IMRT techniques, though, which reduces the risk of error because of the patient moving. A 2022 study published in Radiation Oncology reported that a machine-learning-based planning method optimized the delivery of radiation to tumors and reduced exposure to other organs.
Previous research has shown that patients could benefit from radiation therapy after having a lung removed. Recent studies support the idea that radiation therapy can also be tailored for patients who undergo lung-sparring surgery.
Because VMAT is a cutting-edge technology, though, not every hospital and cancer center is equipped to offer it.
Many people with mesothelioma travel to access top-notch treatment. Because it is rare, few oncologists know how to treat mesothelioma. Seeking a specialist helps people access the latest therapies.
Benefits and Risks of IMRT
IMRT treatment relies on careful planning and complex imaging techniques. With the right preparation, a computer can control exactly how much radiation each part of the patient’s body receives.
IMRT maximizes radiation exposure in the tumor site and minimizes exposure in healthy cells. This allows doctors to administer higher doses of radiation even when the tumor site is next to a sensitive organ such as a lung.
Expert Insight
Radiation is not fun, but it is bearable. The combination of targeted radiation and immunotherapy had an effect. My tumors didn’t go away, but growth slowed to a comparatively glacial pace.
Michael Cole, pleural mesothelioma survivor and Survivor Advocate at The Mesothelioma Center
Of course, no treatment is 100% safe. Some patients do experience adverse reactions to IMRT. Radiation toxicity can lead to inflammation in lung tissue or pneumonitis. At its most extreme, it can cause irreversible damage by hardening the lung’s air sacs, which prevents them from inflating, making it impossible for the patient to breathe. Radiation can also damage the muscles in the heart.
Fortunately, improvements in IMRT techniques have reduced the risk of severe side effects, which has contributed to the rise of lung-sparring surgery in multimodal treatment. Radiation is not part of every mesothelioma patient’s treatment plan. Each patient must discuss with a mesothelioma specialist whether this treatment is appropriate for them.
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Selby, K. (2026, February 9). Intensity-Modulated Radiation Therapy (IMRT) for Mesothelioma. Asbestos.com. Retrieved May 7, 2026, from https://www.asbestos.com/treatment/radiation/imrt/
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Selby, Karen. "Intensity-Modulated Radiation Therapy (IMRT) for Mesothelioma." Asbestos.com, 9 Feb 2026, https://www.asbestos.com/treatment/radiation/imrt/.
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Selby, Karen. "Intensity-Modulated Radiation Therapy (IMRT) for Mesothelioma." Asbestos.com. Last modified February 9, 2026. https://www.asbestos.com/treatment/radiation/imrt/.
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In January of 2016, my husband was diagnosed with peritoneal mesothelioma. Our first reaction was: what is this and what can we do? He was diagnosed by an oncologist and was scheduled to start chemotherapy. When we arrived home that day, I googled mesothelioma and discovered The Mesothelioma Center had a form to fill out to request additional information. I filled it out and within an hour, I received a phone call from Karen Selby from The Mesothelioma Center asking if I needed any help. Karen was and still is my lifeline. She located a doctor at the Cleveland Clinic who performed surgery and HIPEC on peritoneal mesothelioma patients. My husband was scheduled with an appointment and his surgery was performed on March 3, 2016. He continued with follow-up appointments with the oncologist until a friend of ours passed away from it in 2017. Immediately I sent Karen an email asking if she knew any mesothelioma specialists at the clinic, and of course, I got a prompt response back with a name. Everything was going well until the last CAT scan, which showed it returned. He is now doing chemo and has his next CAT scan scheduled for the end of March with a follow-up for the results with the mesothelioma doctor. Without Karen, I am not sure my husband would still be here. She provided me with so much information along with help in various ways, too numerous to even mention. Thank you to all those who are there to help us.
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Michael Cole , pleural mesothelioma survivor and Survivor Advocate at The Mesothelioma Center
