Radiation Therapy

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Radiation therapy is one of the three main types of treatment options for mesothelioma. Using targeted radiation an oncologist can kill cancer cells and shrink tumors, generally with less side effects than chemotherapy. This treatment can be used in all stages.

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Radiation therapy developed into a key component of a still-evolving, three-pronged approach to the treatment of mesothelioma. The most recent medical data shows that in combination with surgery and chemotherapy, radiation can help kill cancer cells. Radiation’s increased ability to target these cells in patients can relieve pain and improve life expectancy, depending on the stage of someone’s cancer.

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 come with chemotherapy. It is a valuable tool to stunt the growth and shrink the size of cancerous tumors.

Although unable to eliminate or cure the cancer, radiation has been most effective as a way to relieve some of the pain that accompanies mesothelioma. It can be used for a variety of reasons to treat patients in different stages of cancer.

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Primary Role of Radiation Therapy

Radiation Therapy Effectiveness

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

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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.

Doctors can determine that some people are not eligible for surgery. For those patients, a combination of chemotherapy and radiation therapy may be chosen to relieve pain and improve their mesothelioma life expectancy. Oncologists also can decide that other patients don't qualify for comprehensive treatment, but can have surgery followed by radiation. Results from multiple clinical trials show this two-pronged treatment approach, without chemotherapy, can help.

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, so 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.

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Radiation and Pleural Mesothelioma

Asbestos cancer experts see more positive results from radiation on individuals with pleural mesothelioma than they do on other forms of the disease. There are two types of radiation used to treat pleural mesothelioma – external beam radiation and intraoperative radiation.

External Beam Radiation

External beam radiation is noninvasive and involves high-energy rays 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 linear accelerator is guided by computers that deliver specific doses to precise areas, making sure healthy cells are not damaged.

Patient undergoing external beam radiation

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

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

Intraoperative Radiation

Intraoperative radiation is used as part of the surgical procedure where 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

Photo Credit University of California-San Francisco

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. It may be placed during surgery or inserted using a hollow tube under a local or general anesthesia with the aid of an imaging scan.

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.

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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.

Radiation Use Restricted

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.

Malignant Seeding

Doctors aim radiation at 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.

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 Vary by Mesothelioma Type

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

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.

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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.

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Major Complications Less Likely with Specialized Radiation

Radiation can cause severe complications, although these conditions are rare. 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.

These specialized forms include:

  • Smartbeam Image Modulated Radiation Therapy
  • Stereotactic Radiation Therapy
  • Proton Therapy

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.

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Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining Asbestos.com in 2009.

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  5. http://www.americanbrachytherapy.org/aboutBrachytherapy/BrachyFAQFinal2.pdf
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  7. Giuseppe, S., et al. (2008). Non-Surgical Treatment of Malignant Pleural Mesothelioma: Radiotherapy and Chemotherapy. In Edt. By A. Baldi, Mesothelioma from Bench Side to Clinic (pp. 405-412). New York: Nova Science Publishers, Inc.
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  9. Smith, R., Hahn, S. (2005). Treatment of Mesothelioma with Radiotherapy. In Pass, H., Vogelzang, N. & Carbone, M. (Eds.), Malignant Mesothelioma (pp. 616-627). New York: Springer.

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