Radiation Therapy Types

Radiation therapy is known to relieve the pain associated with pleural mesothelioma. Patients can receive the treatment before, during, or after surgery in an attempt to shrink tumors and reduce pain. Radiation therapy can also prevent cancer growth and recurrence and is generally known to have fewer side effects than chemotherapy.

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Understanding Radiation Therapy for Mesothelioma

Radiation is used to shrink tumors before surgery or kill cancerous cells during/after surgery. It is also successful in preventing the spread of mesothelioma.

While radiation therapy alone cannot cure mesothelioma, it is often part of an effective combination treatment plan that has garnered support over the past few years due to its promising results.

There are three types of radiation treatment used for pleural mesothelioma:

  • External beam radiation therapy
  • Intraoperative radiation therapy
  • Brachytherapy

Radiation can cause side effects, including fatigue, the development of fibrosis (scarring), or skin problems. It is typical for the skin surrounding the radiation area to be red, swollen, or sensitive during or immediately after treatment.

What Are the Types of Radiation Therapy for Mesothelioma?

In addition to the timing of radiation therapy — whether it’s administered before, during, or after surgery — there are also different radiation therapy techniques used to treat mesothelioma.

External Beam Radiation Therapy

External beam radiation is noninvasive and directly targets the malignant (cancerous) tumors. During the procedure, a machine is used to radiate the tumor through the skin.

According to research in 2004, a delivery of high-dose RT to the entire hemithorax in the lung has not been shown to deliver any additional survival benefit.

However, when used during the extrapleural pneumonectomy (EPP) surgery, a higher dose can be provided to the affected area.

The stronger dose has a significant benefit because the treatment is more localized, meaning there is less chance of the radiation destroying cells surrounding other working organs.

The use of external beam radiation therapy after (P/D) ‘lung-sparing’ surgery is actively being explored in an effort to improve cancer control while minimizing toxicity.

External beam radiation therapy is painless. The beams are only administered for a few minutes each session, and there are two types of radiation to choose from, depending on the condition of the patient.

The two types of external beam radiation therapy are:

  • Three-Dimensional Conformal Radiation Therapy: Radiologists use a scanner to create a three-dimensional image of the pleural tumors. They then examine the data and decide on the intensity of the radiation beam, which will be delivered directly to the tumor. This helps to avoid unnecessary radiation in the healthy tissue surrounding the tumor and just focuses on killing the cancerous cells.
  • Intensity-Modulated Radiation Therapy (IMRT): IMRT is often used to treat pleural mesothelioma after surgery, as this particular method of radiation changes the strength, pattern, and shape of the radiation beams to protect the surrounding tissue. It offers a direct impact on the area that needs to be treated, so there is less worry about the tissue surrounding the cancerous cells.

Intraoperative Radiation Therapy (IORT)

IORT is applied to the patient during surgery.

If a patient has early-stage pleural mesothelioma and is eligible to undergo surgery (be it either EPP or P/D), radiation can be directly applied to the area. This has proved very effective as it avoids passing radiation through healthy cells.


This form of RT is less used than external beam radiation therapy as it is still being researched in clinical trials. Instead of radiation being performed on the outside of the skin, brachytherapy entails tiny radioactive seeds being surgically placed next to the tumor.

This procedure can be permanent or temporary, though for pleural mesothelioma it tends to be permanent so that the chest does not have to be opened again.

After the radioactive ‘seeds’ have been implanted, they will release radioactive waves to kill off the cancerous cells and, in the process, break down the tumors.

Did You Know?

Permanent brachytherapy usually takes place on an outpatient basis, and the patient will then have radioactive objects residing in their body for life.

Temporary brachytherapy requires more frequent visits to the hospital, but it means that patients can live for a period without the radioactive seeds within them.

A less invasive way of using radioactive objects with brachytherapy is through high-dose surface brachytherapy, in which a radioactive object is placed on the skin near the tumor.

A radioactive application is then placed onto the surgical incisions from the mesothelioma operation, which helps deliver focused radiation to the area. Again, this will halt the spread of mesothelioma cells and kill tumor growth.

However, due to the high dose needed to penetrate the skin, the patient is often required to stay in the hospital overnight to ensure a healthy recovery.

Radiation can often make patients feel fatigued, nauseous, and have an irritable sensation on the skin. They may also have a loss of appetite and energy, so it’s important to rest until side effects subside.

Ways to Administer Radiation Therapy

There are several ways to administer radiation to patients. Each method takes into account the disease stage, patient’s health, and available surgery options.

Whether the patient receives radiation before, during, or after surgery is decided on a case-by-case basis, but evidence shows that radiation is an effective treatment to kill mesothelioma cells and avoid the spread of tumors regardless of when it is administered.


Neoadjuvant means that radiation is given before the main surgery treatment. This can be used on mesothelioma patients undergoing the extrapleural pneumonectomy (EPP) procedure.


Adjuvant therapy is used after EPP or P/D surgery. This is because both methods aim to remove as much of the tumor growth as possible, but cancerous cells can still exist on a microscopic level.

A course of adjuvant radiation helps to kill these cells and avoid further tumor growth.

Surgery for Mesothelioma After Radiation Therapy (SMART)

SMART is a newer procedure that may be a promising way to treat pleural mesothelioma.

The approach begins with intensity-modulated radiation therapy (IMRT) before undergoing EPP surgery to administer a high dose of radiation to the body.

Many experts argue that this destroys healthy cells alongside the tumors, but others say that the cells around the tumor will be removed anyway during surgery, so they don’t need to worry about the damage done through radiation.

Did You Know?

The SMART approach also means that the patient may have fewer side effects.

Patients undergoing SMART receive IMRT five days before surgery. Studies have shown encouraging results with SMART as it pertains to overall survival.

Personalized Radiation Therapy for Mesothelioma

If you’ve been diagnosed with mesothelioma, it’s essential to see a mesothelioma specialist to ensure you receive the correct treatment.

Because mesothelioma is such a rare form of cancer, the symptoms and stage can be misinterpreted by doctors who are less familiar with the disease.

For a patient to receive radiation, doctors must be confident on the stage of the tumors, which can only be determined through a biopsy and accurate diagnosis. The mesothelioma specialist will be able to give you a tailored radiation plan based on your unique case.

Some patients require radiation before the surgery, whereas others require radiation afterward. In other cases, radiation can be administered during surgery, but it is paramount that the specialist is aware of all health conditions before the radiation plan can be finalized.

For more information on undergoing personalized mesothelioma treatment, contact our team today.

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.

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