Written By: Devin Golden
Mesothelioma Radiation
Mesothelioma radiation therapy is a treatment for mesothelioma, a rare and aggressive cancer caused by asbestos exposure. This therapy involves the use of high-energy radiation, such as X-rays or proton beams, to target and destroy cancer cells while minimizing damage to surrounding healthy tissue. Radiation therapy can be combined with surgery and chemotherapy to shrink tumors, eliminate residual cancer cells after surgery, or relieve symptoms like pain and breathing difficulties in advanced stages.
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
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Important Facts About Mesothelioma Radiation
- Radiation sends energy beams into the chest cavity to kill cancer cells.
- Radiation is painless for the patient. It’s similar to receiving an X-ray imaging scan.
- Most doctors prefer using radiation after surgery and other therapies, such as chemotherapy and immunotherapy.
- Radiation can reduce tumor size before surgery or kill lingering cells not removed during an operation.
- Some doctors suggest radiation as a palliative treatment. It can relieve pain by shrinking tumors, softening the pressure against the chest.
What Is Mesothelioma Radiation?
Radiation therapy is a noninvasive treatment used to manage mesothelioma. While radiation therapy doesn’t kill the cancer cells immediately, it inflicts long-term structural damage to the cells.
Radiation machines deliver precise, high-energy beams-such as X-rays or protons, to target malignant tumors. These beams disrupt the genetic material of mesothelioma cells, which prevents replication and slows the growth of cancer. Over time, the damaged cells cannot divide. The cells eventually die, making radiation a critical tool in controlling and treating mesothelioma.
What Is the Process for Mesothelioma Radiotherapy?
Radiation therapy is administered by a licensed radiation oncologist, who is a doctor specializing in the use of radiation to treat cancer. The process begins with a planning stage known as “simulation.” During simulation, the oncologist uses imaging scans, such as a CT scan or MRI, to map out the exact area of the body that will be targeted by the radiation. This ensures precise treatment while protecting healthy tissues.
After the simulation is complete, the patient undergoes treatment sessions. To ensure accuracy, immobilization devices, such as molds or straps, might be used to keep the patient still during the procedure. Patients typically lie flat on a table beneath the radiation machine, while lead shields or other protective measures may be employed to safeguard healthy areas from exposure.
The specifics of the process can vary depending on the type of radiation being used. For example, proton therapy may require additional steps for precision targeting, while other methods like external beam radiation may involve a series of short, daily sessions. Each approach is tailored to the patient’s condition and treatment goals.
How Long Does Radiation Last?
A typical radiation therapy session lasts about 10 minutes, but the entire visit to the medical facility usually takes approximately 30 minutes. This includes preparation time, which can take 10-15 minutes, and a short observation period afterward to monitor for side effects such as nausea or fatigue.
Radiation treatment is usually five days a week, with the total duration of therapy ranging from several weeks to a few months depending on the patient’s specific diagnosis and treatment plan. The oncologist tailors the schedule to maximize effectiveness while minimizing side effects.
The length and frequency of sessions, as well as the overall duration of the treatment, can vary depending on the type of radiation used. For example, proton therapy or stereotactic radiation may follow different protocols than traditional external beam radiation.
Additionally, cancer centers may have unique procedures or equipment that influence the treatment schedule. For example, Memorial Sloan Kettering Cancer Center, a leading institution for mesothelioma treatment, begins radiation therapy 4-6 weeks after surgery. Patients receive the therapy for 5-6 weeks.
Your health care team will provide a personalized plan based on your individual needs.
Different Multimodalities for Radiation
Multimodal therapy for malignant mesothelioma involves using different treatment methods together. Radiation is a key element to multimodality for this rare disease.
Doctors use radiation as one part of a lengthy treatment process. The plan often starts with mesothelioma surgery. Doctors also team radiation with:
How to Get Radiation for Mesothelioma
If you want to learn more about radiation for the treatment of mesothelioma, here are steps that can help:
- Meet with a specialist at a mesothelioma cancer center. They’ll provide their expert insight into your treatment options and explain the risks and benefits regarding radiation therapy. They may work directly with a radiation oncologist or can refer you to one.
- Learn about the different types of radiation therapy. The traditional type is called photon radiation, but other methods have emerged in the 21st century. Intraoperative radiotherapy (IORT) may be an option if you’re eligible for surgery.
- Meet with a radiation oncologist. Learn your schedule for treatment, including how many sessions you’ll have and the time between each one. You should also review the possible side effects.
Radiation for Pleural Mesothelioma
Radiation therapy for pleural mesothelioma involves delivering high-energy beams into the chest. This targets diseased tissue in the chest cavity and pleura, which is the lining that surrounds the lungs and chest wall. Because of the proximity to vital organs like the heart and lungs, radiation oncologists carefully balance treatment effectiveness with minimizing damage to healthy tissues.
For pleural mesothelioma, radiation therapy often focuses on one side of the chest, a technique known as “hemithoracic radiation” treatment. To protect critical structures like the heart and abdomen from radiation exposure, doctors use specialized shields or blocks to prevent radiation scatter.
Pleural mesothelioma specialists may recommend hemithoracic radiation with extrapleural pneumonectomy (EPP), which is a surgery for pleural mesothelioma. This radical surgery removes the affected lung, the pleura, and sometimes parts of the diaphragm or pericardium. Radiation may be administered before, during or after EPP surgery to target any remaining cancer cells in the lung cavity.
Doctors also use radiation before, during or after pleurectomy with decortication (P/D), which is a less radical, lung-sparing surgery. Since this procedure preserves both lungs, radiation oncologists exercise caution to minimize harm to the healthy lung tissue while effectively treating the disease.
These tailored approaches to radiation therapy play a critical role in improving outcomes for patients with pleural mesothelioma.
Recommended Dosage for Pleural Mesothelioma
Radiation therapy dosage for pleural mesothelioma can vary by hospital or treatment center, as different protocols may be followed. However, guidelines published in the Journal of Thoracic Oncology, developed in collaboration with the National Cancer Institute and International Association for the Study of Lung Cancer, offer standardized recommendations for radiation dosage:
- Hemithoracic radiation after EPP (Extrapleural Pneumonectomy) — 45-60 Gy (grays), delivered in 1.8-2.0 Gy fractions, focuses on treating the chest cavity after the removal of the affected lung to destroy residual cancer cells
- Hemithoracic radiation before EPP — 25-30 Gy, delivered in 5-6 Gy fractions, used to reduce tumor size and improve surgical outcomes while minimizing risks
- Hemithoracic radiation with P/D — 50.4 Gy, delivered in 1.8 Gy fractions, targets the diseased pleura while sparing both lungs, requiring precise administration to protect healthy tissue
When radiation is used after EPP, lower doses are directed toward the remaining lung to minimize the risk of radiation-induced pneumonitis (scarring and inflammation of lung tissue). The Journal of Thoracic Oncology notes that reducing radiation dosage in these cases has successfully decreased pneumonitis rates to below 10%, reflecting the importance of balancing effective treatment with patient safety.
Radiation for Peritoneal Mesothelioma
Radiation is not an accepted therapy for peritoneal mesothelioma. Peritoneal mesothelioma forms in the abdominal cavity, near many vital organs. The risk of radiation damage to these organs outweighs the benefits.
Doctors may recommend palliative radiation for symptom management and quality of life. These treatments are delivered at low dosages.
Mesothelioma Survival Rates From Radiation
Radiation before or after surgery significantly improves life expectancy for mesothelioma patients. Multiple studies from leading cancer centers showcase the benefits of this therapy.
In one study, hemithoracic radiation with P/D had a two-year survival rate of 58%. Only nine of the 55 patients experienced grade 2 or worse pneumonitis.
Radiation before EPP also has impressive mesothelioma survival rates. A median survival of 24.4 months included biphasic and sarcomatoid cell types. Epithelioid cell cases have even better survival, including a 3-year survival rate over 70%.
Types of Radiation for Mesothelioma
There are a few different types of radiation for malignant mesothelioma. They differ in the size (radius) and intensity of the energy beams. The three main types are:
- Photon beam radiation — This is also called external beam radiation (EBRT). It’s the original type of radiation treatment. The radiation machine sends X-ray beams into the patient’s body to kill cancer cells. The one concern is radiation spray hitting healthy tissue outside the target area. Most cancer centers no longer use photon beam radiation therapy for mesothelioma.
- Intensity-modulated radiation therapy (IMRT) — This type uses a targeted beam (smaller radius) and requires a lower dose than proton beams. Most cancer centers now use IMRT for mesothelioma treatment.
- Proton beam radiation — This is the newest type of radiation therapy. Proton beams are the most targeted method, limiting the damage to healthy tissue. It also requires the lowest dosage for effective treatment. This type of radiation usually requires less time in the facility, fewer sessions per week and fewer cycles.
Proton radiation is growing in popularity. The overall use of proton radiation tripled from 2004-2018, according to a report in JAMA Oncology. More than 1% of cancer patients now use proton radiation, and nearly 1% of lung cancer patients go with this type.
When to Use Radiation
There are varying beliefs and opinions about when to use radiation for mesothelioma. Since surgery is the key treatment for beating cancer, specialists build a therapy plan around the operation.
The three different ways to use radiation are:
- Before surgery (neoadjuvant radiation) — Doctors use radiation to contain or shrink tumors before surgery. This approach is called “SMART”, which stands for surgery for mesothelioma after radiation therapy. It is growing in popularity after impressive survival rates.
- During surgery (intraoperative radiation) — Doctors have direct access to the chest cavity and administer energy beams before closing the incision. This method avoids damage to skin tissue and healthy organ tissue.
- After surgery (adjuvant radiation) — Doctors use radiation after surgery to diminish the chance of recurrence. This method kills cancer cells not removed during surgery. This approach is called “IMPRINT”, which stands for intensity-modulated pleural radiation therapy.
Palliative Radiation for Mesothelioma
Radiation is also used as palliative therapy for people with late-stage mesothelioma cancer. Doctors target tumors with low-strength beams to relieve pressure, to manage symptoms and improve quality of life.
Tumors build up in the pleural cavity and on the surface of the lungs. Taking up space in the pleural cavity means less room for the lungs to expand. This creates chest pain and fluid buildup. Tumors on the lung surface and in lung tissue can also cause side effects, such as a persistent cough, shortness of breath, chest pain, hoarseness, and appetite loss.
Palliative radiation can decrease pleural mesothelioma symptoms. Pain relief may not begin until 10 days after radiation therapy starts. There are a few recommended options for palliative mesothelioma radiation dosage, according to the National Cancer Institute, International Association for the Study of Lung Cancer and Mesothelioma Applied Research Foundation:
- 30-39 Gy, given in 3 Gy fractions
- 20-40 Gy, given in 4 Gy fractions
Frequently Asked Questions About Radiation for Mesothelioma
Are there different types of radiation for mesothelioma?
There are three types of radiation for mesothelioma: photon, intensity-modulated and proton therapy. Photon radiation is the traditional X-ray type, also known as external beam radiotherapy (EBRT). Intensity-modulated radiation therapy (IMRT) conforms the beam to the shape of the tumor. Proton radiation uses proton beams rather than X-rays, which reduces damage to healthy tissue.
What are the common side effects of mesothelioma radiation?
Damage to healthy lung tissue is the most common side effect of mesothelioma radiation. This damage can cause scarring, which is a medical condition called pulmonary fibrosis. Other side effects include:
- Nausea
- Fatigue
- Skin problems (itchiness, dryness or peeling)
- Coughing
- Shortness of breath
Does radiation improve mesothelioma survival?
Radiation therapy can improve survival for mesothelioma patients particularly when used in combination with other treatments such as surgery and chemotherapy. For instance, some studies indicate that patients undergoing this multimodal approach can achieve post-treatment survival of approximately 30 months. Additionally, a study conducted at Michigan Medicine found that administering radiation before mesothelioma surgery led to a median survival of more than four years.
Where can I get radiation for my mesothelioma?
Most cancer centers offer radiation therapy for mesothelioma. If the center has a dedicated team for mesothelioma cases, they likely have state-of-the-art radiotherapy equipment and an on-staff radiation oncologist. Our Doctor Match service can help you find a hospital offering radiation as part of its treatment protocol.
Sources & Author
- Radiation Therapy to Treat Cancer. National Cancer Institute. Retrieved from: https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy. Accessed: 07/12/2021.
- Radiation Therapy Process. Stony Brook Cancer Center. Retrieved from: https://cancer.stonybrookmedicine.edu/RadiationTherapyProcess. Accessed: 07/12/2021.
- The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation. Journal of Thoracic Oncology. Retrieved from: https://www.jto.org/article/S1556-0864(19)30380-6/fulltext. Accessed: 07/14/2021.
- Radical Hemithoracic Radiotherapy Versus Palliative Radiotherapy in Non-metastatic Malignant Pleural Mesothelioma: Results from a Phase 3 Randomized Clinical Trial. International Journal of Radiation Oncology. Retrieved from: https://www.redjournal.org/article/S0360-3016(20)34597-1/fulltext. Accessed: 07/14/2021.
- Radiation Therapy for Mesothelioma. Memorial Sloan Kettering Cancer Center. Retrieved from: https://www.mskcc.org/cancer-care/types/mesothelioma/treatment/radiation-therapy. Accessed: 07/14/2021.
- Assessment of Proton Beam Therapy Use Among Patients With Newly Diagnosed Cancer in the US, 2004-2018. JAMA Network. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791568. Accessed: 05/06/2022.
