Radiation Therapy for Mesothelioma

What Is Radiation Therapy for Mesothelioma?

Radiation therapy, also known as radiotherapy, for mesothelioma is a treatment that targets and kills cancer cells with powerful beams of energy. Doctors aim the energy at mesothelioma tumors to shrink them, control spreading and prevent them from returning. Unlike chemotherapy, radiation is localized and doesn’t circulate through the bloodstream.

Key Facts About Radiation for Mesothelioma 

1. Radiation therapy uses high-energy X-rays or protons to kill cancer cells.
2. Advanced types of radiation use imaging such as PET and CT scans to precisely target mesothelioma tumors.
3. A radiation oncologist plans how much radiation to use and where to deliver it to target the tumor and avoid normal tissues.
4. Radiation can provide effective tumor control and symptom relief, and may improve overall survival for some people. 

People with mesothelioma may consider radiation as an anticancer treatment when combined with other therapies like surgery or immunotherapy. Radiation alone can be a palliative treatment to ease mesothelioma symptoms. 

Radiation doesn’t cure mesothelioma, but it can help people feel better and live longer. Sometimes, doctors use it alone to ease pain or help someone breathe better. People generally don’t feel anything during radiation treatment, but it can cause side effects later. 

Insight From a Mesothelioma Specialist

“I believe that radiation therapy for mesothelioma and other asbestos-related diseases is getting better. Its benefits are improving. This treatment option holds great promise and is advancing each day.”

Sean Marchese, RN and oncology writer at The Mesothelioma Center

How Does Radiation Work for Mesothelioma?

Radiation therapy uses high-energy X-rays or particles to fight mesothelioma. These types of radiation damage the DNA of mesothelioma cells and kill them. Your normal cells are better at repairing after radiation treatments than mesothelioma cells. 

High-energy beams or particles of radiation enter your body at the site of your cancer. Registered Nurse Sean Marchese tells us they disrupt cancer cell growth and prevent it from spreading.

Marchese explains, “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.”

Sometimes, radiation can also trigger a rare immune response called the abscopal effect. This means radiation not only shrinks the treated tumor but also helps shrink tumors elsewhere in the body that the radiation didn’t directly target. This effect shows how radiation may help the entire body fight mesothelioma when combined with immune-based treatments.

Radiation Therapy for Pleural Mesothelioma

Pleural mesothelioma is the type of this cancer most commonly treated with radiation therapy. Radiation therapy targets tumors on the lung lining to treat pleural mesothelioma. New technology uses imaging to target specific doses of radiation into pleural tumors. Targeting tumors on the lung lining is generally safer than targeting those on the abdominal lining in peritoneal mesothelioma cases. 

At high doses, radiation therapy damages the DNA in pleural cancer cells. It kills them or slows their growth. This gradually affects their ability to multiply and survive. When the damaged cells die, the body breaks them down and removes them.

Today, doctors use advanced imaging and techniques such as IMRT, IGRT and proton therapy. These methods let them target tumors precisely while protecting healthy lung tissue. 

Pleural mesothelioma survivor Michael Cole tells us, “Radiation for pleural mesothelioma isn’t fun, but it’s manageable. It took us fully a year to get my SAbR/PULSAR radiation treatment at UT Southwestern in Dallas approved… and I doubt that I would be here without it.”

Radiation Therapy for Peritoneal Mesothelioma

Radiation therapy isn’t generally recommended for treating peritoneal mesothelioma. It’s difficult to deliver high-dose radiation to peritoneal tumors without harming vital organs. Because the organs in your belly are closely packed together, high doses of radiation can easily damage them and cause severe side effects.

Rather than growing as a single mass, mesothelioma grows and spreads as many small tumors on the peritoneal lining. This lining folds upon itself as it wraps around abdominal organs. This creates double layers, making delivery of radiation even more difficult.

Past research on radiation for peritoneal mesothelioma found it effective in some cases, but some patients died from radiation toxicity. The risk of severe harm often makes high-dose radiation too dangerous for peritoneal mesothelioma. Some peritoneal patients have safely received radiation to surgical incisions to prevent tumor spread, or localized tumors that are causing symptoms. 

Types of Radiation Therapy for Mesothelioma

Radiation therapies for mesothelioma include external and internal radiation. External beam radiation delivers high-energy X-rays from a machine outside the body directly to mesothelioma tumors. This noninvasive procedure can shrink tumors and prevent local recurrence. 

Doctors recommend external beam radiation because it appears to be more effective and safer than internal radiation for mesothelioma. Internal radiation for mesothelioma involves placing radioactive material into or near the tumor. 

External Beam Radiation Therapy

External beam radiation therapy is a noninvasive procedure for mesothelioma. It directs high-energy radiation at mesothelioma tumors. EBRT can target large areas, shrink tumors and improve symptoms. Doctors recommend it for palliative care and aggressive multimodal therapy plans.

Types of External Beam Radiation Therapy

• 3-D conformal radiation therapy: 3D-CRT imaging creates a 3D map of the tumor. It allows precise targeting of radiation beams.
• Image-guided radiation therapy: IGRT uses imaging before and sometimes during treatment. This is to adjust as the tumor position or the patient’s body changes and accurately treat the tumor
• Intensity-modulated radiation therapy: IMRT is an advanced form of 3D-CRT. It varies the intensity of the radiation beams and delivers treatment as the beams move in arcs. IMRT can allow for better tumor treatment and minimize exposure to nearby healthy tissues.
• Proton therapy: This treatment uses protons, not photons. For some people it may allow for reduced radiation dose to normal tissues and reduced side effects. It’s available at select cancer centers. 
• Stereotactic body radiotherapy: SBRT uses one machine for imaging and radiation and delivers a short course of higher dose, precise treatments. SBRT is typically delivered over 1 to 5 days. It allows continuous imaging to improve accuracy during treatment.
• Volumetric modulated arc therapy: VMAT is an advanced form of IMRT that delivers radiation continuously as the machine rotates around the patient, allowing for shorter treatment times while maintaining highly precise and conformal dose distribution..

These types of EBRT can target the tumor and spare healthy tissue. IMRT is a standard, precise and effective treatment. Proton therapy is less common but very effective in some cases.

Internal Radiation Therapy

Internal radiation therapy for mesothelioma involves placing radioactive material into the body. This can be done systemically or put directly into or near the tumor.

It can shrink tumors and may stop cancer from spreading. While not commonly recommended, this treatment has been beneficial when used in conjunction with other therapies.

Mesothelioma Radiation in Multimodal Therapy

Radiation therapy for mesothelioma is used with surgery, chemotherapy and immunotherapy in multimodal therapy. Combining radiation with other therapies can reduce the risk of recurrence and improve survival rates, which is why the National Comprehensive Cancer Network recommends radiation as part of a multimodal approach for pleural mesothelioma. Doctors are still researching the best time to deliver radiation. It has been administered before, during and after surgery. 

In the past, doctors applied radiation after lung removal with an extrapleural pneumonectomy or EPP. New technology now allows delivery of high-dose radiation with a low risk of lung damage. Today many surgeons favor surgery that keeps the lung, known as pleurectomy/decortication or P/D. The IMPRINT phase II trial found radiation can be safely applied after a pleurectomy/decortication.

Mesothelioma Radiation Before Surgery

Radiation therapy before surgery for mesothelioma involves a 2-step plan. First, doctors treat pleural mesothelioma patients with a high dose of intensity-modulated radiation, which is currently used at a limited number of centers. Then, they remove the entire affected lung and lung lining with EPP. Reversing the usual order of surgery and radiation can extend survival rates. But this protocol has a risk of radiation toxicity.

Research shows a median survival of 51 months for patients who had surgery for mesothelioma after radiation therapy or SMART. A study published in 2020 followed up with 5 SMART patients. Researchers report 4 patients were alive after a year. One had no cancer recurrence after 2.7 years.

Mesothelioma Radiation During Surgery

Intraoperative radiation therapy gives a single high dose of radiation to mesothelioma tumors during surgery, while the tumor is exposed. This method minimizes exposure to healthy tissues. IORT is less common for treating mesothelioma compared to other radiation therapies. But it offers significant benefits in some cases.

One of the key advantages of IORT is its ability to deliver high doses of radiation in a single session. It can target cancer cells that are left after surgical tumor removal. Using radiation during surgery lowers the risk of cancer returning. It can also make the treatment more effective.

Mesothelioma Radiation After Surgery

Adjuvant radiation therapy for mesothelioma is radiation after surgery. It targets any remaining cancer cells that surgery missed. This therapy can lower the risk of recurrence and improve survival rates. 

Studies show better overall survival when radiation is delivered after P/D compared to EPP. The 2-year survival rates for radiation and P/D range from 40% to 68%. The 2-year survival rates for radiation and EPP range from 18% to 57%.

Insight From a Mesothelioma Specialist

“If you’re not a candidate for surgery, radiotherapy can do almost as well as surgery. And the combination of the two is even better, like 40% better, and that’s significant.”

Dr. Emanuela Taioli, Epidemiologist at Mount Sinai Hospital

Benefits of Radiation Therapy for Pleural Mesothelioma

Radiation therapy shrinks tumors and stops the spread of pleural mesothelioma. This extends survival, relieves pain and improves quality of life. 

Mesothelioma survivor Michael Cole says radiation made a difference for him. He tells us, “The combination treatment of targeted radiation and immunotherapy that I received didn’t make my tumors disappear, but it had a real effect that dramatically slowed their growth.” 

Key Benefits of Mesothelioma Radiation Therapy

• Improved survival: A combined or multimodal therapy approach that includes radiation may help some people live years longer.
• Pain relief: Approximately 60-80% of people with mesothelioma report symptom relief after radiation therapy.
• Seeding prevention: Preventive radiation along surgical cuts may limit cancer spread. Seeding is the term used for this.
• Tumor reduction: Radiation therapy shrinks pleural tumors. It eases pain and pressure on the lungs, chest or spine.

A 2023 study in the journal Cancers reviewed outcomes for thousands of pleural mesothelioma cases. It found radiation therapy nearly doubled 2- and 5-year survival rates. This study also noted a reduction in complications such as fluid buildup. 

Research shows early-stage pleural patients often live longer if they receive radiation, surgery and chemo. Studies also show radiation of incisions reduces cancer spreading for pleural patients who undergo surgery. 

Michael Cole

Verified Asbestos.com Survivor

SAbR/PULSAR Radiation Is a Success for Pleural Mesothelioma Survivor

I’ve had SAbR targeted radiation therapy and SAbR/PULSAR radiation treatment. It turned out that my SAbR/PULSAR radiation treatment at UT Southwestern in Dallas was a dramatically successful round of treatment for me, and I doubt that I would be here without it. I currently see doctors at UT Southwestern Dallas for follow ups with the radiation oncologist.

Michael Cole

Verified Asbestos.com Survivor

Read Michael’s Story

Can Radiation Therapy Benefit Other Mesothelioma Types?

Research is limited on the benefits of radiation for pericardial mesothelioma. Similar to the potential risk of harm to vital organs with radiation for peritoneal cases, there is a risk of heart damage for pericardial patients. 

Although, one 2024 report described a person with pericardial mesothelioma who did successfully receive intensity-modulated radiation therapy with surgery, chemo and immunotherapy. The combined treatment shrunk tumors, prevented new growth and relieved symptoms. 

Studies on the testicular type show it may not be responsive to radiation therapy. Treatment for this mesothelioma type mainly involves surgery to remove the tumor. Patients need regular check-ups to catch any recurrence.

Side Effects of Radiation Therapy for Mesothelioma 

Side effects of mesothelioma radiation include fatigue, skin problems and hair loss in the treatment area. Research shows radiation causes pleural effusions, or fluid buildup in the chest, in 67% of cancer patients. 

Common Mesothelioma Radiation Therapy Side Effects

• Cough, fever and fullness of the chest (radiation pneumonitis)
• Difficulty swallowing
• Fatigue
• Fluid buildup (pleural effusions)
• Hair loss near the radiated area
• Scarring of the lungs (radiation fibrosis)
• Shortness of breath
• Skin problems

Pleural effusions can lead to chest pain and shortness of breath. These effusions occur on the same side of the chest where radiation was given. This likely results from inflammation and scarring that block drainage.

A risk of radiation toxicity may develop at high doses. Symptoms include: nausea, vomiting, skin burns and, in severe cases, seizures and confusion. Early recognition and management care can help prevent long-term issues. Some side effects of radiation may be chronic and appear months or years after the treatment. They include a low risk of secondary cancer. 

What to Expect from Mesothelioma Radiation Therapy

Usually, mesothelioma radiation patients first consult with a radiation oncologist. Once they’re fully informed of the process and want to proceed, they might have to sign a consent form. Imaging scans are then done and reviewed. 

Radiation therapy is then given as outpatient treatment. It’s important to follow what your radiation therapy team explains you should do before, during and after treatment. 

Mesothelioma Radiation Therapy Process

1. Consultation: Your radiation oncologist will discuss the best approach and treatment plan for you. 
2. Imaging scans: Imaging scans show the exact size, shape, and location of tumors. This helps to precisely target tumors and prevent harm to healthy tissue.
3. Treatment: You’ll be positioned and covered to prevent radiation exposure to your healthy tissue. You won’t feel the radiation during delivery. Radiation is typically applied 1 or more times a week for 10 to 30 minutes per session for several days to several weeks.
4. Follow-up appointment: Your doctor will check for side effects at follow-ups. More imaging scans help doctors see if radiation has shrunk your tumor.

After treatment, your care team will monitor your response to radiation therapy. They’ll treat any side effects, such as skin rashes, as needed. Tell your doctor quickly if any side effects develop to limit their progression. 

Radiation oncologists work closely with other oncologists, oncology nurses, pathologists and diagnostic radiologists. Your radiation oncologist will consult your medical team. Then, they’ll discuss the best approach for your case with you. Your radiation oncologist may discuss a clinical trial with you. They may also share how recent trials can benefit you.

Is Radiation Therapy Right for You? 

Your mesothelioma specialist will carefully review all aspects of your diagnosis, overall health, the latest research and treatment guidelines before creating the best plan for you. There is no one-size-fits-all treatment for mesothelioma, so your care will be tailored to fit your unique needs.

Your care team will study clinical trials and examine when radiation therapy is most effective for mesothelioma. The type of tumor and mesothelioma cells you have will influence whether radiation is helpful. They will also consider the stage of your cancer, your age and any other health conditions you have. This detailed review helps select the treatment with the most benefits and the least risks for you.

Insight From a Mesothelioma Specialist

“Even if radiation isn’t the ultimate cure, it’s still a good thing if we can get patients a significant amount of quality time with minimal side effects. Things are getting better.”

Dr. Kenneth Rosenzweig, mesothelioma radiation oncologist at Mount Sinai Medical Center

Who Is Eligible for Mesothelioma Radiation Therapy?

People who are in good overall health may be candidates for radiation therapy to treat mesothelioma. Early-stage patients often qualify for radiation combined with surgery, while those in later stages usually receive palliative radiation to ease symptoms. The best candidates have no serious health problems that could make radiation unsafe.

Patients with mesothelioma tumors recurring in 3 to 5 distant locations might also qualify for radiation. Recent research suggests radiation can help control the growth of distant metastases, but its use must be limited.

Eligibility for Mesothelioma Radiation Therapy

• You’re healthy enough to handle regular radiation treatments.
• You can stay still during treatments.
• You don’t have excessive fluid buildup that would make targeting tumors difficult.
• You don’t have other serious illnesses, like heart disease or additional lung conditions.
• Your lung and kidney functions are strong.

Doctors use scans and tests to decide if radiation therapy will help you. They check the stage of your cancer, the size and location of tumors and your overall health. A breathing test assesses if your lungs can tolerate therapy. If radiation can precisely target tumors without harming healthy organs, you may qualify.

Your care team will explain the risks and benefits clearly and will listen to your concerns. If radiation is a good option, they will support you through every step of treatment.

Common Questions About Radiation Therapy for Mesothelioma

Can radiation cure mesothelioma?

Radiation doesn’t cure mesothelioma, but it can help slow cancer spread. It can shrink tumors and make breathing easier. Doctors often use radiation to ease pain or stop cancer from spreading. Some people get radiation after surgery to kill cancer cells that remain.

How long does radiation therapy last?

Radiation treatment for mesothelioma usually lasts 4 to 6 weeks. Most people go to the clinic 5 days a week for a short session each time. The full plan depends on your health, the tumor’s size, and where it is. Your doctor will create a schedule just for you.

Can I work during radiation treatment?

Some people can keep working during radiation. It will depend on how you feel. Radiation may cause tiredness or skin changes that make it hard to do daily tasks. Your doctor can help you decide what is safe and manageable.

Can mesothelioma be treated with radiation alone?

Radiation by itself usually cannot eliminate mesothelioma because the cancer tends to spread widely. It’s most effective when combined with surgery and/or chemotherapy. In some cases, radiation may be used to ease symptoms in advanced disease.

What are the side effects of mesothelioma radiation therapy?

Common side effects include fatigue, skin irritation near the treatment area, cough, difficulty swallowing and shortness of breath. Side effects can be managed with care, and your treatment team will monitor and support you throughout therapy.

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