What Is Radiation Therapy for Malignant Mesothelioma?

Radiation for mesothelioma is treatment using ionizing radiation, which consists of high-energy X-rays or particles, to damage the DNA of cancerous cells and kill them. This treatment can extend survival and relieve pain for people with mesothelioma. The therapy results in tumor shrinkage and helps prevent cancer recurrence and spread.

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.

At high doses radiation therapy damages cancer cells’ DNA, killing them or slowing their growth. This gradually affects their ability to multiply and survive. Cancer cells with DNA damaged beyond repair stop dividing or die. When the damaged cells die, the body breaks them down and removes them.

Types of Radiation for Mesothelioma

Radiation treatments for mesothelioma include external and internal therapies, each with a variety of specific types. External beam radiation is the most common type of radiation therapy for mesothelioma. It involves aiming high-energy rays directly at malignant tumors. This noninvasive procedure is effective in targeting and shrinking tumors and is often used for pleural mesothelioma.

Another type of radiation for mesothelioma is internal radiation, which involves placing radioactive material into or near the tumor. This treatment is less commonly used than external beam radiation.

Example of external beam radiation

External Beam Radiation

External beam radiation is the most common type of radiation therapy for mesothelioma.

Image guided radiation therapy

Types of External Beam Radiation Therapy

Types of external beam radiation therapy for mesothelioma include 3-D conformal radiation therapy, image-guided radiation therapy and proton therapy.

Internal radiation therapy

Internal Radiation Therapy

Systemic radiation therapy is a type of internal radiation therapy and can involve delivering treatment via an IV.

Brachytherapy example


Brachytherapy is a type of internal radiation therapy that delivers radiation directly to mesothelioma tumors.

IV treatments and brachytherapy are two forms of internal radiation therapy. Understanding the types and applications of radiation therapy can help you and your healthcare team discuss options and can make informed decisions about the best approach for your mesothelioma treatment.

External Beam Radiation Therapy

External beam radiation therapy (EBRT) is a noninvasive procedure that directs high-energy rays at malignant tumors to treat mesothelioma. This method is particularly effective for pleural mesothelioma. It can target large areas and reduce tumor size, alleviating symptoms and improving the patient’s quality of life.

Types of External Beam Radiation Therapy
  • 3-D Conformal Radiation Therapy: 3D-CRT imaging creates a three-dimensional representation of the tumor, allowing precise targeting of radiation beams
  • Image-Guided Radiation Therapy: IGRT takes imaging before and after treatment to adjust as the tumor position or patient’s body changes
  • Stereotactic Body Radiotherapy: SBRT combines imaging and radiation delivery in 1 machine, allowing continuous imaging to improve accuracy and precisely focus beams during treatment
  • Intensity-Modulated Radiation Therapy: IMRT is an advanced form of 3D-CRT that varies the intensity of the radiation beams, providing higher doses to the tumor while minimizing exposure to surrounding healthy tissues
  • Proton Therapy: This treatment uses protons instead of photons, offering more precise targeting of mesothelioma tumors with reduced side effects and is available at select cancer centers

These types of EBRT are used specifically for mesothelioma based on their ability to deliver targeted treatment while preserving healthy tissue. IMRT is a common treatment because of its precision and effectiveness, while proton therapy is less common but highly effective in certain cases.

Internal Radiation Therapy

Internal radiation therapy involves placing radioactive material into the body, either systemically or directly into or near the tumor. Though used less frequently for mesothelioma, internal therapies can be an effective treatment option in specific cases.

Types of Internal Radiation Therapy
  • Brachytherapy: Implanting radioactive material directly into the tumor site delivers high doses of radiation precisely where it’s needed, reducing the impact on surrounding tissues.
  • Systemic Radiation Therapy: Delivering radioactive substances throughout the body via an IV line targets cancer cells wherever they may be in the body.

Internal radiation therapy provides a focused approach to treating mesothelioma, particularly when used to target specific tumor sites. Brachytherapy for mesothelioma may be a recommended treatment option because of its ability to deliver concentrated radiation doses directly to mesothelioma tumors, shrinking tumors effectively and potentially preventing the spread of cancer cells.

These treatments can be especially beneficial when used in conjunction with other therapies. Options that target tumors directly help to maximize the overall effectiveness of the mesothelioma treatment plan.

Radiation in Multimodal Therapy

Multimodal therapy for mesothelioma involves combining multiple treatment methods to improve patient outcomes. Radiation therapy is a key component of this approach, often used alongside surgery and chemotherapy to enhance the overall effectiveness of treatment.

Integrating radiation with other therapies allows doctors to target cancer cells more comprehensively, reducing the risk of recurrence and improving survival rates. This approach leverages the strengths of each treatment modality to create a more robust defense against mesothelioma.

Recent research supports the effectiveness of multimodal therapy. Studies show that combining radiation with surgery and chemotherapy can significantly extend survival and improve the quality of life for mesothelioma patients. For instance, the use of helical tomotherapy following lung-sparing surgery has demonstrated safety and efficacy in treating locally advanced malignant pleural mesothelioma.

A 2023 study on the role of surgery to remove recurring or residual tumors (salvage resection) after definitive radiation therapy for non-small cell lung cancer offers insights that may apply to mesothelioma treatment strategies. Additionally, research that looked at how surgical inflammation could affect immune response during intraoperative photodynamic therapy shows how important it is for doctors to consider immune system interactions in multimodal treatments.

Intraoperative Radiation Therapy 

Intraoperative radiation therapy is a procedure where a concentrated dose of radiation is delivered directly to a tumor site during surgery. This method allows for precise targeting of cancer cells while minimizing exposure to surrounding healthy tissues. IORT isn’t as commonly used for mesothelioma as other types of radiation therapy, but it offers significant benefits in certain cases.

One of the key advantages of IORT is its ability to deliver high doses of radiation in a single session. This is particularly beneficial for mesothelioma patients, as it can effectively target residual cancer cells that may be left behind after tumor removal. Applying radiation during surgery reduces the risk of cancer recurrence and can enhance the overall effectiveness of the treatment.

While IORT is a promising option for some mesothelioma patients, specific characteristics of the tumor and the overall treatment plan typically determine its use. Doctors will consider factors such as tumor location, stage of the disease and your overall health when deciding if IORT is an appropriate part of your multimodal therapy plan.

Radiation Therapy After Surgery

Radiation therapy after surgery, also known as adjuvant radiation therapy, is designed to target any remaining cancer cells that surgery didn’t remove. An important step in the treatment process for mesothelioma patients, this therapy can reduce the risk of recurrence and improve overall outcomes. 

During the initial consultation, you’ll meet with a radiation oncologist to discuss the best approach for your case. Imaging scans will determine the exact size, shape and location of any remaining tumors. Based on these images, your oncologist will develop a personalized treatment plan to ensure accurate and safe application of radiation. The goal is to target residual cancer cells while minimizing exposure to healthy tissues.

Radiation therapy is typically administered on an outpatient basis, with sessions scheduled 1 or more times a week for several weeks. A medical professional will explain the process and guide you through each step, from positioning and protective coverings to the actual application of radiation. Follow-up appointments are essential to monitor for side effects and assess the effectiveness of the treatment through imaging scans.

Surgery for Mesothelioma After Radiation Therapy

The surgery for mesothelioma after radiation therapy protocol involves first treating pleural mesothelioma patients with a high dose of intensity-modulated radiation and then removing the entire affected lung and lung lining in an extrapleural pneumonectomy procedure. Reversing the usual order of surgery and radiation can extend survival rates, but this protocol also has notable risks.

Research indicates a median survival of 51 months for patients who underwent the SMART protocol. A study published in 2020 followed up with 5 SMART patients. Researchers report 4 of the patients were still alive more than a year later, and 1 patient showed no cancer recurrence after 2.7 years. 

However, the high fatality rate for EPP may mean this treatment isn’t suitable for the majority of patients. In addition, the high levels of radiation the lung receives can be fatal in itself, making surgery a necessity for patients following the radiation treatment.

I believe the benefits of radiation therapy for mesothelioma and other asbestos-related diseases are continuously improving. This treatment option holds great promise and is advancing each day.

Sean Marchese

Benefits of Radiation Therapy for Mesothelioma

Radiation therapy offers significant benefits for mesothelioma patients, helping to extend survival, relieve pain and prevent the spread of cancer. Patients can receive this treatment at various stages of the disease, either alone or in combination with other therapies such as surgery and chemotherapy.

Key Benefits of Radiation Therapy
  • Improved Survival: Some patients may live 3 to 5 years longer with a multimodal therapy approach that includes radiation.
  • Pain Relief: Approximately 60% of mesothelioma patients report symptom relief after radiation therapy.
  • Tumor Reduction: Radiation therapy reduces the size of mesothelioma tumors, alleviating pain and pressure on the lungs, chest or spine.
  • Seeding Prevention: Preventive radiation along incisions may help prevent cancer cells from spreading or “seeding.”

Incorporating radiation therapy into the treatment plan for mesothelioma provides multiple advantages. Radiation therapy reduces tumor size and alleviates pain, enhancing quality of life for patients. When combined with other treatments, it can significantly improve survival rates and prevent the spread of cancer cells.

Benefits of Radiation for Pleural Mesothelioma

A 2023 study reviewed outcomes for thousands of pleural mesothelioma cases and found overall survival at 2 and 5 years nearly doubled for patients who received radiation therapy. These findings underscore the potential benefits of incorporating radiation therapy into the treatment plan for pleural mesothelioma. This study also noted a reduction in complications such as fluid buildup.

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.

In another recent study, researchers concluded that radiation of incisions was successful in reducing spreading for pleural mesothelioma patients who underwent chest wall procedures. An additional study reported longer overall survival for early-stage pleural patients who received radiation therapy, surgery and chemotherapy.

Can Radiation Therapy Benefit Other Mesothelioma Types?

Radiation therapy is commonly used for treating pleural mesothelioma. Its benefits for peritoneal, pericardial and testicular mesothelioma are more limited because of various factors related to tumor location and sensitivity to radiation.

Radiation therapy is less commonly used for peritoneal mesothelioma because the proximity to the intestines, liver and kidneys makes it challenging to deliver effective radiation doses without causing damage. Pericardial mesothelioma, which affects the lining around the heart, typically isn’t treated with radiation therapy for similar reasons. 

Malignant mesothelioma of the testicular tunica vaginalis is extremely rare and has a poor prognosis. This type of mesothelioma isn’t sensitive to radiotherapy or chemotherapy. Treatment primarily involves surgery to remove the tumor and patients require regular monitoring to detect any recurrence.

Survivor Story
Survivor Story
Michael Cole Pleural Mesothelioma

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.

Read Michael’s Story

Side Effects of Mesothelioma Radiation Therapy

Side effects of mesothelioma radiation are most often temporary and are typically more constrained than those of chemotherapy, which can affect the entire body. However, some side effects of radiation may be chronic and appear months or years after the patient finishes treatment. They include a low risk of secondary cancer.

Common Radiation Therapy Effects
  • Cough, fever and fullness of the chest (radiation pneumonitis)
  • Difficulty swallowing
  • Fatigue
  • Hair loss near the radiated area
  • Scarring of the lungs (radiation fibrosis)
  • Shortness of breath
  • Skin problems

With a high risk of radiation toxicity, debate about its role in improving quality of life for mesothelioma patients is ongoing. Its damage to cell DNA to kill cancer cells affects cancer cells more severely than normal cells, but side effects from the death of healthy cells are still common. Early recognition and management care can help prevent long-term issues.

Radiation therapy in the chest may cause pleural effusions. This buildup of fluid between the lungs and the chest wall can cause chest pain and shortness of breath. Research indicates pleural effusions occur on the same side of the chest receiving radiation in 67% of cancer patients, likely when inflammation and tissue scarring cause blockages.

Patient holding side speaking with doctor
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What to Expect from Mesothelioma Radiation

In general, mesothelioma radiation patients go through an initial consultation, get imaging scans and then receive treatment on an outpatient basis. Understanding the radiation therapy process can help you prepare for treatment.

Radiation Therapy Process
  1. First Appointment: During the consultation visit, you’ll meet with a radiation oncologist to discuss the best approach for your case. You might have to sign a consent form once you’re fully informed of the process and want to proceed.
  2. Imaging Scans: To ensure accurate and safe application, doctors use imaging scans to determine the exact size, shape and location of tumors.
  3. Treatment: A medical professional will explain what you need to do before, during and after treatment. They’ll help position you and apply protective coverings to prevent radiation exposure to healthy tissue. Radiation is typically applied 1 or more times a week for several weeks.
  4. Follow-Up Appointment: During follow-up appointments, your doctor will check you for signs of side effects. Further imaging scans help doctors keep a close watch on how the radiation affects the size of your tumors.

Radiation oncologists work closely with other members of a multidisciplinary cancer care team. This includes other oncologists, oncology nurses, pathologists and diagnostic radiologists. Your radiation oncologist will consult your medical team and then discuss the best approach for your case with you.

Your radiation oncologist may also lead clinical trials to find new and improved treatments for mesothelioma. They may discuss the possibility of participating in a clinical trial with you or how what they’ve learned in recent trials can benefit you. For example, a recent study found prophylactic irradiation could prevent metastasis after a chest wall procedure.

Is Radiation Therapy Right for You? 

There is no one-size-fits-all treatment for mesothelioma. Experts analyze multiple clinical studies and determine what works best in specific situations. Mesothelioma treatment guidelines help doctors decide the best  treatments for individual patients based on their specific type of cancer and health status.

Doctors select mesothelioma treatments for patients after determining the type of mesothelioma, mesothelioma cell type and mesothelioma stage. Additional factors, including age, coexisting conditions and performance status, are also important when determining which treatment options provide the most benefit with the lowest risk of harm.

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