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What Is External Beam Radiation Therapy?

When a pleural mesothelioma patient receives radiation, it is almost always a type of external beam radiation.

The machine that creates the radiation is usually a linear accelerator, or linac machine.

In aggressive multimodal treatment, doctors typically use radiation after surgery to kill cancer cells left behind. This strategy is associated with better survival rates for patients.

Doctors may also use radiation before or during surgery. A 2021 research study noted that patients who received external beam radiation therapy after pleurectomy and decortication surgery had an overall survival of 13.5 months.

On its own, radiation therapy can relieve chest pain by shrinking tumors. Patients can also receive radiation at the same time as chemotherapy and immunotherapy.

External Beam Radiation Facts

  • Most common type of radiation therapy for pleural mesothelioma
  • Requires advanced technology to administer safely
  • Should be performed by experienced mesothelioma specialists
  • Leading techniques for mesothelioma are IMRT and proton therapy

Radiation therapy has mild side effects compared to chemotherapy for pleural mesothelioma.

However, doctors have to be very careful when giving a patient radiation therapy in the chest, as it can easily damage the lungs and heart if doctors do not aim it carefully.

Hyperthermic intrathoracic chemotherapy (HITHOC) is an experimental alternative to radiation therapy. HITHOC may benefit patients who undergo lung-sparing surgery for pleural mesothelioma.

When mesothelioma specialists use radiation, they rely on the most advanced technology available.

Radiation therapy is limited for peritoneal mesothelioma treatment. Doctors may use it to prevent surgical tools from spreading cancer cells. Stronger types of radiation treatment are too dangerous to use in the abdomen.

External beam radiation therapy for pleural mesothelioma
External beam radiation therapy aims a beam of radiation at cancerous tumors.

Key Innovations in Radiation Therapy

In traditional radiation therapy, high-energy X-rays pass all the way through the patient’s body in a straight line.

The radiation damages the tumor, but it also affects the healthy tissue in front of and behind the tumor.

Pleural mesothelioma develops in the membrane on the outside of the lungs. Radiation oncologists must use special methods to make sure they can target the cancer without hurting nearby lung and heart tissue.

  • Three-dimensional conformal radiation therapy (3D-CRT) involves hitting the cancer from many different angles. This concentrates the radiation in the cancer while limiting how much radiation the rest of the body receives. Stereotactic body radiation therapy (SBRT) is a similar technique.
  • Radiation oncologists can use image-guided radiation therapy (IGRT) to make sure they concentrate the radiation on the right target. This involves scanning the patient’s body before each radiation treatment. They also pay close attention to how the tumor site moves in the body when the patient breathes.
Brigham and Women's Hospital and the Lung Institute at Baylor College of Medicine
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Types of External Beam Radiation for Mesothelioma

Image-guided 3D radiation is advanced, but not advanced enough for pleural mesothelioma.

Mesothelioma specialists constantly test the best available technology in the hopes of helping their patients live longer, better lives.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT involves hitting the cancer from many different angles and changing the intensity of the radiation to suit each angle.

Radiation oncologists use image scanning and computer modeling to fine-tune the radiation treatment.

A leading-edge form of this technique is called helical tomotherapy. In this approach, a patient lays inside a donut-shaped machine. This machine can shine image-guided, intensity-modulated radiation on the patient from any angle.

Another new form is volumetric modulated arc therapy (VMAT), which is faster and more accurate than standard IMRT.

A technique developed specifically for pleural mesothelioma patients is called intensity-modulated pleural radiation therapy (IMPRINT).

Proton Therapy

Instead of using a beam of X-rays, some specialized cancer centers can use a beam of protons to kill cancer cells.

The great advantage of proton therapy is that it causes much less collateral damage to healthy cells around the tumor site.

Because there is less risk to the rest of the patient’s body, radiation oncologists can give the tumor site a more lethal dose of energy. Proton therapy is not yet a common treatment for mesothelioma.

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