Radiation Therapy

Radiation therapy is one of the three primary treatment options for mesothelioma. Generally, radiation can shrink mesothelioma tumors with fewer side effects than chemotherapy. This treatment can be used in all stages.

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Radiation therapy for mesothelioma cancer can relieve pain, prevent cancer cells from spreading and improve life expectancy. Oncologists use it either in combination with other treatments or alone as a single treatment to control pain and spreading.

Oncologists have used radiation as a cancer treatment for decades. But technological advancements make it a much more refined treatment today. Despite its toxicity, well-targeted radiation can work without causing some of the serious side effects that often accompany chemotherapy.

Although unable to eliminate or cure the cancer, radiation can relieve some of the pain that accompanies mesothelioma and prevent spreading. It can be used for a variety of reasons to treat patients in different stages of cancer.

Benefits of Radiation Therapy

Decades of research has proven three primary benefits of radiation therapy for mesothelioma.

Benefits of Radiation Therapy

  • IV icon

    Improved Survival: When combined with surgery and chemotherapy, radiation can help you live longer by reducing the risk of local recurrence.

  • Lungs icon

    Pain Relief: Radiation therapy alleviates pain by reducing the size of mesothelioma tumors, which relieves pressure on the lungs and chest.

  • Incision icon

    Seeding Prevention: Radiation therapy along incision sites is common, as seeding occurs in 20 to 50 percent of mesothelioma patients who undergo these procedures. Even modest radiation at surgery or drain tube sites can help.

Types of Radiation for Mesothelioma

Radiation for mesothelioma can be applied externally and internally. The internal form is called brachytherapy. The external form is called external beam radiation therapy (EBRT).

These two types of radiation are applied in different ways and EBRT is more commonly used because it has proven more effective for mesothelioma. Brachytherapy is used in specialized mesothelioma cancer centers by experts who know which patients will benefit the most.

External Beam Radiation Therapy

External beam radiation is noninvasive and involves high-energy rays directly targeting malignant tumors. It's performed by an experienced radiologist who has considered tumor size, location, staging of the cancer and general health of the patient.

To help lessen the risk of adverse reactions, the radiation machine is guided by computers that deliver specific doses to precise areas, making sure healthy cells are not damaged.

The radiation beam conforms to the 3-D shape of the tumor and is emitted in multiple doses. It permits higher radiation doses within the tumor, while minimizing the dose to the surrounding organs and tissues.

Patient undergoing external beam radiation

There are different types of EBRT:

  • Intensity-Modulated Radiation Therapy (IMRT): The most effective type of radiation to combine with surgery and other treatments.
  • Three-Dimensional Conformal Radiation Therapy (3D-CRT): Used less often for mesothelioma because IMRT is safer and more effective.
  • Image-Guided Radiation Therapy (IGRT): Imaging scans are taken before, during and after application of radiation to precisely target tumors and spare healthy tissue.
  • Tomotherapy: This image-guided form of IMRT is only available at certain mesothelioma cancer centers.
  • Proton Therapy: Instead of using beams of light, this therapy uses beams of protons, the positively charged particles found in the nucleus of an atom.

Brachytherapy

Brachytherapy is a type of radiation therapy that minimizes any damage to healthy tissues while killing the cancerous cells with a radioactive material implanted in the tumor. The radioactive material may be placed during surgery or inserted using a hollow tube under a local or general anesthesia with the aid of an imaging scan. Brachytherapy is also applied temporarily to biopsy and surgical scars to prevent cancer spreading.

Clinical trials are testing the therapy, but it's not yet a standard treatment for mesothelioma. It has been effective in treating lung cancer when placed into a tumor site. It slowly loses its radioactivity over time.

Timing Impacts Results

EBRT is applied at different times for different effects. EBRT as a single treatment can be applied at any time to control pain. When combined with surgery, EBRT can be applied before, during or after the procedure.

The following terms are used to describe the different times in which radiation is applied:

  • Intraoperative Radiation Therapy (IORT)
  • Surgery for Mesothelioma After Radiation Therapy (SMART)

FAST FACT: The treatment itself is fast and painless, done on an out-patient basis and is usually performed five days a week for several weeks.

Intraoperative Radiation Therapy

Intraoperative radiation is used as part of the surgical procedure. A radiologist applies the beams to the affected areas to help prevent any seeding or spreading of the cancer cells during the operation.

Although traditionally used at the end of an aggressive extrapleural pneumonectomy (EPP) surgery, surgeons in Toronto recently have begun using high-dose radiation before surgery and finding it most effective.

Intraoperative radiation therapy

Photo Credit University of California-San Francisco

Surgery for Mesothelioma After Radiation Therapy

The mesothelioma specialists at Princess Margaret Cancer Institute in Toronto devised the SMART approach to help people live longer by reducing cancer recurrence following surgery. They succeeded in their goal. Around 66 percent of patients with early-stage epithelioid tumors lived longer than three years.

It takes an experienced multidisciplinary team to safely execute the SMART approach. A high level of radiation is applied to the lung prior to surgery that could be fatal if the lung isn’t subsequently removed. This means that once a patient receives radiation, they must follow through with surgery.

Radiation Therapy After Surgery

Traditionally, multimodal therapy for mesothelioma begins with chemotherapy, followed by surgery and then radiation therapy once the patient recovers from surgery. In this setting, radiation is used to kill cancer cells that were left behind in surgery. This technique reduces the risk of local recurrence or delays recurrence.

About half of early-stage patients with epithelioid mesothelioma can live longer than five years with this treatment.

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Radiation and Peritoneal Mesothelioma

While radiation therapy can have a significant impact for someone with pleural mesothelioma, the treatment is more limited for those with the second-most common disease type, peritoneal mesothelioma. The reason is location.

Peritoneal cancer involves the lining in the abdominal cavity. Radiation is restricted in this area because it can be extremely toxic to the small intestines, liver, kidneys and other organs within that cavity.

The only kind of radiation used on peritoneal patients is to prevent cancer spreading to biopsy and surgical scars. Doctors apply radiation to scars on the abdomen to prevent malignant "seeding" of the area where a surgical incision was made. Seeding occurs when cancerous cells are accidentally dropped into an area when the tumor is removed.

Radiation Therapy Process

Most people are not sure what to expect when radiation therapy is applied. In general, patients go through an initial consultation, get imaging scans, and then receive treatment on an outpatient basis (unless they are receiving radiation during surgery).

  • First Appointment: During the consultation visit, you will meet with a radiation oncologist to discuss the best approach for your case. During this initial visit, you might be asked to sign a consent form once you are fully informed of the process and want to proceed with treatment.
  • Imaging Scans: To ensure accurate and safe application, imaging scans are performed to determine the exact size, shape and location of tumors. The application of radiation is based upon these images to ensure safety.
  • Treatment Day: A medical professional will explain what you need to do before, during and after treatment. They will help position you and apply protective coverings to prevent radiation exposure to healthy tissue. Radiation is typically applied one or more times a week for several weeks.
  • Follow-up Appointment: During follow-up appointments you will be checked for signs of side effects and imaging scans will be taken to keep a close watch on how radiation affected the size of your tumors.

Common Side Effects of Radiation Therapy

Side effects of radiation therapy are most often temporary and limited to the treatment site. However, some may also be chronic and appear months or years after the patient finishes treatment.

Most side effects develop as tissue damage accumulates over several sessions of radiation. A single cycle may last up to eight weeks, during which the patient may begin to notice side effects. As treatment progresses, effects are often more severe.

The most common side effects of radiation include:

  • Skin Problems: Radiation-related irritation, known as radiodermatitis, is most common at the point where the radiation beam was focused. It can cause rashes, redness and a tight feeling or swelling. Peeling or darkening of the skin may occur.
  • Fatigue: It is typically most severe two to four hours after a radiation session. It may also peak between the third and fifth week of treatment as the healing process uses more of the patient's energy.

Radiation Side Effects by Mesothelioma Type

Advanced methods of delivering radiation therapy can help reduce the amount of surrounding tissue exposed to radiation, but some side effects may still occur in the area where the radiation entered the body.

Inflammation, scarring and damage to the heart muscle are less common in patients who receive highly specialized forms of radiation therapy.

Some of the most sophisticated machines are able to specifically target the cancerous area and reduce the amount of surrounding tissue that is exposed to radiation. Side effects of radiation are typically more constrained than those of chemotherapy, which can affect the entire body.

The type of mesothelioma diagnosis can affect how a person’s body will react to radiation therapy.

Pleural Mesothelioma

Receiving radiation treatments to the chest could temporarily intensify symptoms of pleural mesothelioma such as shortness of breath, difficulty swallowing and coughing.

In rare cases, scarring of the lungs, called fibrosis, may occur.

Radiation to the chest can also cause inflammation of the lungs or the lining of the heart, along with damage to the heart muscle, a condition known as cardiac toxicity. Other rare but major complications can include pleural effusions, collapsed lungs and calcification of the lymph nodes. Researchers show that pleural effusions, if they develop at all, are typically reported within six months of the initial radiation treatment.

Lungs Icon

Peritoneal Mesothelioma

Nausea and vomiting are most common in peritoneal mesothelioma patients who receive radiation to the abdomen and sustain damage to their gastrointestinal tract. These side effects are also common in patients receiving additional treatments, especially chemotherapy.

When radiation is directed at the abdomen, the bladder may be affected by the powerful rays, resulting in bladder irritation. It may be difficult to completely empty your bladder, urinate at normal intervals or control the flow of urine from your bladder when you cough or sneeze. Inflammation in the bladder, known as cystitis, may also occur.

In rare cases, urine may appear bloody or the bladder may begin to cramp or spasm. These side effects may appear within three to five weeks of treatment.

 Peritoneum Icon

Is Radiation Treatment Painful?

Cancer patients often ask their oncologist if radiation therapy is painful. The good news is that radiation therapy is not painful during administration. There’s no need to worry about pain while receiving the treatment.

After treatment, some people may experience skin irritation around the area where radiation is delivered. This irritation may feel and resemble sunburn. For example, the skin may turn pink or red and you may notice burning, itching, soreness or peeling. Unlike typical sunburn, this irritation usually develops gradually in patches rather than immediately.

Pleural mesothelioma patients receiving radiation therapy to the chest may develop a cough or sore throat, which usually dissipates with time.

Radiation therapy relieves pain for people with mesothelioma by shrinking tumors that press against the lungs, chest or abdomen. While it may cause some painful skin reactions or pulmonary side effects, these are temporary and treatable.

Fatigue is a common after radiation therapy, but this side effect isn’t painful.

Some Experts Question Radiation Benefits

Despite recent advancements a number of experts question the merits of radiation therapy for mesothelioma. These concerns arise from the inconsistent results published in clinical trials and scientific studies on radiation’s effect on mesothelioma.

It seems that specialized mesothelioma treatment centers are the only ones capable of applying radiation safely and effectively. These facilities have the latest radiation equipment and a team of mesothelioma experts who know how to apply radiation on people with this rare cancer.

Radiation May Improve Quality of Life, Survival

Research shows that radiation therapy for mesothelioma improves pain levels, reduces recurrence and lengthens survival.

  • More than 60 percent of mesothelioma patients report relief of symptoms after radiation therapy.
  • One study reported a 14 percent recurrence rate among mesothelioma patients treated with IMRT compared with a 42 percent recurrence rate among patients treated with conventional radiation.
  • The addition of radiation therapy to multimodal treatment with surgery and chemotherapy improves survival by months or years depending upon the technique applied. Some patients live three to five years longer with this approach.

The decision to include radiation therapy in your treatment plan is up to you and your oncologist. The potential benefits of the therapy might outweigh the risks and side effects. However, you need to discuss the pros and cons thoroughly with your oncologist to make an informed decision.

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Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections.

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