Mesothelioma Radiation Therapy

Radiation therapy is a standard treatment for mesothelioma that many patients undergo. A non-invasive treatment, radiation therapy has minimal side effects and can significantly contribute to increased life expectancies when used as part of a multimodal treatment plan.

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Radiation Therapy for Mesothelioma Overview

All patients diagnosed with mesothelioma should become aware of the standard treatment options available to them. Radiation therapy is one of the standard treatment options that may be offered to you, but many patients don’t know what to expect from it or how it works.

If your doctor has recommended radiation therapy as part of your mesothelioma treatment plan, then here is what you need to know about this anti-cancer treatment:

  • Radiation therapy uses high-energy rays aimed directly at the mesothelioma location to shrink tumors
  • Doctors take a series of images from X-rays and CT scans to find the exact location and extent of mesothelioma before starting radiation
  • Knowing exactly where to target the radiation helps radiologists be more accurate in their dosages and prevent damaging surrounding healthy tissue
  • Different radiation techniques have different treatment goals
  • Radiation therapy can be used on its own or along with surgery and/or chemotherapy to improve treatment success rates
  • Before treatment begins, all patients should seek the second opinion of an oncological radiologist who specializes in mesothelioma

Radiation Therapy Goals

Being diagnosed with mesothelioma is an overwhelming experience and many patients feel confused by what all the treatments mean and what they are for. That’s why it’s important for anyone who is undergoing radiation therapy to know exactly why doctors use it to treat mesothelioma.

Depending on your exact diagnoses, such as mesothelioma location, cell type, and stage, doctors will have different treatment goals. Radiation often plays a very specific role in achieving the overall treatment objective. Radiation may be offered as a solution on its own, but more commonly it’s used in conjunction with surgery.

Here are some of the goals of using radiation therapy to help treat mesothelioma:

  • Shrink tumors before surgery making mesothelioma easier to remove (neoadjuvant)
  • Prevent seeding of mesothelioma to new sites during surgery
  • Kill off microscopic mesothelioma cells left behind after surgery (adjuvant)
  • Shrink tumors to alleviate painful symptoms of metastasis (palliative)

Depending on your diagnosis, doctors may use a certain technique or approach to radiation therapy that will accomplish one or more of the above goals. Radiation therapy technology and techniques are being refined and improved upon all the time. The goal with continuing to develop radiation therapy techniques is to make it more effective as a supporting (adjuvant) treatment with standard mesothelioma surgeries.

Mesothelioma Radiation Therapy Approaches

Mesothelioma Justice Network Brief

There are different ways to administer radiation therapy and a variety of techniques to target mesothelioma tumors. However, radiation therapy operates on the same general principle no matter how it’s administered. High-energy rays, usually from gamma or x-rays, are aimed either externally or internally at the mesothelioma tumor site. Radiologists administer radiation in doses measured for their accuracy in targeting the tumor itself and not the surrounding healthy tissues.


Rays from the radiation are so powerful that they interfere with the mesothelioma cells’ DNA, which is located in its nucleus—the central information system of the cell. Mesothelioma cells receive their instructions to grow and divide from the DNA located in the nucleus. When radiation scrambles cells’ DNA, the cells can no longer divide themselves. Being unable to grow and divide, mesothelioma cells die off—a central biological process called apoptosis or cell death.

External Beam Radiation Therapy

External beam radiation therapy (EBRT) is one approach to radiation therapy. As the name suggests, external beam radiation therapy is administered from outside the body by radiologists using radiation machines.

As the most common form of radiation therapy, EBRT is becoming increasingly more effective at targeting tumors thanks to technological advancements.

For doctors to know exactly where to aim the radiation and how much of it to administer, they need to first examine the patient closely with images taken of the inside of the patient’s body. Many times, mesothelioma tumors are irregularly shaped and form in separate areas, making it an intricate process to fully target it. To achieve full tumor targeting, doctors now use a technique called Intensity-Modulated Radiation Therapy (IMRT).

IMRT combined with a 3D conformal techniques—3D targeting that conforms to the exact tumor shape—radiologists can deliver different dosage levels to different areas of the tumor, depending on which parts need higher strengths of radiation.

The advantages of EBRT are that it’s more accurate, more effective and it does more to minimize damage to healthy tissues than older radiation techniques.

Intraoperative Radiation Therapy

As an alternative to EBRT, doctors can use intraoperative radiation therapy (IORT). Administered directly to the inside of the patient during surgery, IORT is a radiation therapy approach intended to be a supportive (adjuvant) treatment to surgery. By applying radiation therapy directly to the open mesothelioma site, doctors can help increase surgical success by preventing mesothelioma cells from seeding to new sites.

The IORT approach also prevents damage to healthy tissues because it doesn’t have to pass through the skin from the outside as it does with EBRT.

Only given to early-stage mesothelioma patients, IORT has proven to help further increase life expectancy from surgery-based treatment plans. Depending on your exact diagnosis, doctors may recommend the IORT approach with pleural or peritoneal mesothelioma surgeries.

Surgery for Mesothelioma After Radiation Therapy (SMART)

Constantly in search for new and better ways to treat mesothelioma, researchers have developed a relatively recent mesothelioma treatment protocol. Surgery for Mesothelioma After Radiation Therapy—or SMART—is when doctors administer radiation therapy to pleural mesothelioma patients before they undergo the extrapleural pneumonectomy (EPP) surgery.

Mesothelioma Justice Network Brief

Challenging conventional treatment wisdom that radiation therapy should be given after surgery, the developers of the SMART approach discovered that administering radiation therapy before surgery has enormous benefits. During the SMART approach, doctors administer large doses of radiation to the tumor site, knowing that damage to healthy tissue is less of a concern as these tissues will all be removed during the EPP procedure.

Doctors have found that SMART helps to shrink tumors and kill many more microscopic mesothelioma cells. Killing this many outlying mesothelioma cells has ultimately shown to prevent seeding to distant sites—the process of mesothelioma cells moving around during surgery and forming new tumors. By preventing seeding during surgery, doctors using the SMART approach can limit recurrence (when the mesothelioma comes back) and increase survival.

A study from the University of Toronto showed a 3-year survival rate of 84% in pleural mesothelioma patients who underwent SMART.

Such a high survival rate is incredibly promising, as the typical 3-year survival rate in patients is only 10%.

Seeking Mesothelioma Radiation Therapy Treatment

If your doctor has suggested radiation therapy as part of your mesothelioma treatment plan, then it’s important to seek the second opinion of mesothelioma specialists. Having dedicated their careers to researching and treating mesothelioma, specialists know the best practices for administering radiation therapy for mesothelioma. Specialists look at each patient as having a unique disease, and they develop a radiation treatment plan that will best support the overall treatment goal for that patient.

General radiologists don’t have the experience required to treat the complexities of mesothelioma tumors, which grow irregularly and are difficult to target. It’s critical for patients to work with oncological radiologists at specialized mesothelioma treatment centers across the country.

For more information on receiving treatment at a leading mesothelioma cancer center, contact the Mesothelioma Justice Network today. Our Justice Support Team can help answer any questions you may have about radiation therapy, what to expect and how to get a second opinion about this form of treatment.

Don’t delay in getting the radiation therapy you need to help improve your survival and increase your quality of life.

Author:Stephanie Kidd
Stephanie Kidd

Stephanie Kidd is the Editor-in-Chief of the Mesothelioma Justice Network and works tirelessly as a dedicated advocate for the vulnerable and underrepresented. Stephanie worked as a copywriter for an agency whose focus was communicating safety procedures on construction work sites. With her extensive background in victim advocacy and a dedication to seeing justice done, Stephanie works hard to ensure that all online content is reliable, truthful and helpful.

Last modified: May 22, 2019

View 3 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.