Mesothelioma Radiation Therapy

Radiation therapy for malignant mesothelioma uses high-energy X-rays or particles to kill a patient’s cancerous mesothelioma cells. According to the American Cancer Society (ACS), mesothelioma is difficult to treat with radiation because it is hard to hit the tumors with radiation beams without also damaging healthy tissues. However, newer radiation techniques may help some mesothelioma patients, especially when combined with treatments like surgery.

Get a Free Mesothelioma Guide

What Is Radiation Therapy for Mesothelioma?

Mesothelioma radiation therapy is a cancer-fighting treatment that uses beams of radiation to destroy mesothelioma cells.

Mesothelioma doctors use radiation in an attempt to extend survival (curative treatment) and to relieve symptoms caused by the cancer (palliative treatment).

Radiation therapy involves the use of high-energy rays — typically gamma or X-rays — to damage the DNA of cancer cells, causing them to lose the instructions that tell them to grow and divide. As a result, mesothelioma cells die off instead of growing and multiplying.

Doctors usually use one of two types of radiation therapy for mesothelioma:

  • External beam radiation therapy (EBRT): EBRT uses X-rays produced by a machine surrounding a patient to kill cancer cells. According to the ACS, Mesothelioma patients are usually treated with EBRT.
  • Brachytherapy: This radiation treatment involves inserting a radiation source inside a patient’s body in or near tumors. It is rarely used for mesothelioma patients outside of clinical trials.

Before starting radiation, doctors use imaging tests to pinpoint the exact location and extent of mesothelioma. This helps doctors prevent damage to healthy surrounding tissues.

Radiation beams are aimed directly at the site of the tumor. This treatment may be applied differently depending on the stage of mesothelioma and the location of the tumor.

Benefits of Mesothelioma Radiation Therapy

Considered one of the standard mesothelioma treatment options recommended to mesothelioma patients, radiation is typically used during palliative care to reduce symptoms and improve quality of life.

However, it may also be used with surgery or chemotherapy to improve treatment success.

Radiation therapy for mesothelioma has several goals:

  • Shrinking tumors before surgery, so mesothelioma is easier to remove
  • Preventing mesothelioma from spreading to new sites during surgery
  • Killing off mesothelioma cells that were left behind during surgery
  • Shrinking tumor size to alleviate painful symptoms of metastasis

According to the ACS, mesothelioma is difficult to treat with radiation because the tumors do not usually grow as one large mass that mesothelioma doctors can aim a radiation beam at. Instead, mesothelioma tends to spread, covering delicate tissues and organs.

Radiation kills all cells — not just cancerous ones — so it can be difficult for mesothelioma specialists to hit cancer cells with radiation beams without also damaging vital organs.

However, newer radiation techniques allow for better control of radiation beams, potentially making radiation therapy more helpful for some mesothelioma patients.

Types of Radiation Therapy for Mesothelioma

Mesothelioma is usually treated with external beam radiation therapy (EBRT).

Mesothelioma specialists may use different EBRT approaches depending on the goal of treatment and other factors such as mesothelioma type, stage, the tumor’s location, and the overall health of the patient.

Emerging types of radiation therapy are also providing hope for safer, more effective ways of treating mesothelioma.

External Beam Radiation Therapy

External beam radiation therapy is the most common type of radiation therapy. As the name suggests, EBRT is administered through the skin from outside the body. EBRT is becoming increasingly more effective at targeting tumors, thanks to technologic advancements.

Before beginning radiation therapy, doctors must determine precisely where to aim the radiation and how much to administer. To do this, they examine the patient closely by imaging the body.

Mesothelioma tumors are often irregularly shaped and form in separate areas, so targeting the cancer can be complicated.

Did You Know?

To fully target a tumor, doctors now use a technique called intensity-modulated radiation therapy (IMRT).

The IMRT method alters the strength, pattern, and shape of radiation beams to apply radiation more directly and protect the surrounding tissue. This technique allows doctors to conform the radiation beam to the precise shape of the tumor and fine-tune the radiation doses.

Intraoperative Radiation Therapy

Intraoperative radiation therapy (IORT) is a type of EBRT radiation therapy approach used to support surgery. IORT is administered inside the body while the tumor site is exposed during surgery.

By applying radiation therapy directly to the open mesothelioma site, doctors can increase surgical success by preventing mesothelioma cells from spreading.

The IORT approach also prevents damage to healthy tissues since radiation does not pass through the skin from the outside.

Only used on early-stage mesothelioma patients, IORT can further increase life expectancy from surgery-based treatment plans. Depending on a patient’s exact diagnosis, doctors may recommend the IORT approach with pleural or peritoneal mesothelioma surgeries.


Brachytherapy or internal radiation is a type of radiation therapy that works by inserting a radioactive device inside of a patient’s tumor.

Brachytherapy lets doctors use higher doses of radiation in more specific places than traditional radiation therapy would allow.

Doctors may apply brachytherapy in many ways:

  • Inserting the radioactive source during surgery
  • Inserting the radioactive source with the use of an imaging scan
  • Applying it temporarily after surgery to prevent cancer from spreading

Brachytherapy is rarely used to treat mesothelioma, but its effectiveness in treating lung cancer gives some doctors hope that it may help in the future treatment of mesothelioma.

New Radiation Techniques For Mesothelioma

Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation therapy that can make radiation particles fit the shape of the targeted tumor. This makes IMRT more accurate and effective and less damaging than older radiation techniques.

Radiation and Multimodal Therapy for Mesothelioma

Doctors generally use radiation therapy along with chemotherapy for mesothelioma and/or surgery when attempting to increase a patient’s life expectancy.

This combination of multiple cancer treatment methods is known as multimodal therapy.

Surgery for Mesothelioma After Radiation Therapy

Surgery for mesothelioma after radiation therapy (SMART) is only used on patients with malignant pleural mesothelioma who will undergo surgery.

Administering radiation therapy before an extrapleural pneumonectomy (EPP) surgery has significant benefits. With the SMART approach, doctors deliver large doses of radiation to the tumor site to kill tumor cells aggressively.

Preventing Recurrence With Radiation Therapy

Doctors have found that SMART (surgery for mesothelioma after radiation therapy) helps shrink tumors and kills outlying mesothelioma cells, which prevents them from forming new tumors.

Targeting a large area of mesothelioma cells with radiation can prevent mesothelioma from spreading to distant sites during surgery. By using the SMART approach, doctors can limit mesothelioma recurrence and increase survival.

Damaging healthy tissue is less of a concern during this procedure because the entire lung will be removed in the following surgery.

Radiation Therapy Process

While the process of radiation therapy may vary from patient to patient, it generally follows the same basic steps.

1. Initial Consultation

The mesothelioma patient will meet with a radiation oncologist — a cancer doctor who specializes in treating patients with radiation. Patients will be asked to bring documentation such as previous imaging tests and diagnostic test results.

Once there, the radiation oncologist will perform a thorough examination of the patient and answer any questions the patient may have.

After examining the patient, the doctor will determine a radiation therapy treatment plan. Before making any final decisions, however, the plan will be explained to the patient, who must sign a consent form before treatment can proceed.

2. Imaging Scans

Mesothelioma specialists must create accurate imaging to let them know where the target location will be for radiation therapy. They do this using a computed tomography (CT) machine, which takes roughly an hour to create a simulation of the patient’s body.

3. Treatment Preparation

At times, doctors may create a faint marking on a patient to make sure they perform the most accurate radiation treatment possible and avoid as much healthy tissue as they can. They may also create molds to protect a patient’s face or other areas of the body during radiation.

4. Treatment

According to the National Cancer Institute (NCI), radiation treatment is typically performed five days a week and continues for 5-6 weeks.

Did You Know?

The average length of time for daily radiation treatment is 15-30 minutes.

5. Follow-Up Appointment

Follow-up appointments usually involve an examination for any signs of side effects the radiation therapy may cause. A mesothelioma patient’s doctor will also order imaging scans to see if the tumor is shrinking in response to the radiation.

Side Effects of Radiation Therapy

Although radiation oncologists do everything they can to protect surrounding tissues during radiation therapy, damage to healthy cells can occur and may result in side effects. Some patients experience many side effects, while others have very few.

Radiation therapy side effects depend on: 

  • Location of the area under treatment
  • Size of the area being treated
  • Radiation dosage level
  • Treatment frequency

Side effects can happen during therapy, immediately after, or they may take weeks to develop following treatment.

Some common radiation side effects that mesothelioma patients may experience include:

  • Fatigue
  • Loss of appetite
  • Hair loss
  • Nausea
  • Vomiting
  • Skin problems
  • Lung inflammation
  • Inflammation of the intestines

Fortunately, your medical team can help manage any side effects. For example, skin problems are typically treated with topical creams, and inflammation is treated with oral medications.

Seeking Mesothelioma Radiation Therapy

If your doctor has suggested radiation therapy as part of your mesothelioma treatment plan, seek a second opinion from a mesothelioma specialist.

Radiations oncologists know the best ways to administer radiation therapy for mesothelioma to increase survival and minimize damage to healthy tissue.

Specialists develop personalized radiation treatment plans to best support the overall treatment goals of each patient.

For more information about receiving radiation therapy from a mesothelioma specialist, contact the Mesothelioma Cancer Network today.

Our Claim Advocates will answer any questions you have about radiation therapy and how you can get a second opinion.

Mesothelioma Support Team
Reviewed by:Dr. Assuntina Sacco

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

Stephanie KiddWritten by:


Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Cancer Network, Stephanie serves as a voice for mesothelioma victims and their families.

View 5 Sources
  1. American Cancer Society, “Radiation Therapy for Malignant Mesothelioma.” Retrieved from: Accessed on January 3, 2018.
  2. Cancer Research UK, “Mesothelioma: Radiotherapy treatment.” Retrieved from: Accessed on January 3, 2018.
  3. Journal of Thoracic Oncology, “A Feasibility Study Evaluating Surgery for Mesothelioma After Radiation Therapy: The “SMART” Approach for Resectable Malignant Pleural Mesothelioma.” Retrieved from: Accessed on January 3, 2018.
  4. NCI Office of Communications and Public Liaison. (2016). Radiation Therapy and You: Support for People with Cancer [pdf file]. Retrieved April 3, 2020, from
  5. Mayo Clinic Staff. (2018). Brachytherapy. Retrieved April 3, 2020, from
Back to Top