Types of Radiation Therapy for Mesothelioma


Radiation Therapy (RT) 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. RT can also prevent cancer growth and recurrence and is known to have fewer side effects than chemotherapy. While RT alone cannot cure pleural mesothelioma, it is often part of an effective multimodal treatment plan that has garnered support over the past few years due to its promising results.

Radiation Therapy Overview

  • There are three types of radiation treatment used for pleural mesothelioma – External Beam Radiation Therapy, Intraoperative Radiation Therapy, and Brachytherapy.
  • 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.
  • Radiation can cause side effects, including fatigue, the development of fibrosis or skin problems. It is typical for the skin surrounding the radiation area to be swollen or sensitive during or immediately after treatment.

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 all evidence shows that radiation is an effective treatment to kill mesothelioma cells and avoid the spread of tumors.


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 pleurectomy with decortication (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 has been hailed as one of the most promising ways 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 researchers 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. The SMART approach also means that the patient will have fewer side effects and will not have to worry about the strain on their body.

Patients undergoing SMART receive IMRT five days before surgery. Studies have shown that SMART increases the survival rate of EPP patients and gives better postoperative results. A 2014 study on the “SMART” approach for resectable pleural mesothelioma found that 84% of patients who received the procedure lived for three years or longer.

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.

Types of Radiation Therapy

In addition to the radiation therapy approach—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 through the skin to the tumor. 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 surgery (EPP), a higher dose can be provided to the affected area. The stronger dose has a significant benefit because the treatment it is more localized, meaning there is less chance of the radiation destroying cells surrounding other working organs.

External beam radiation therapy is not carried out after a pleurectomy with decortication (P/D) ‘lung-sparing’ surgery as the radiation may cause more damage than good to the lung.

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.

  1. Three-Dimensional Conformal Radiation Therapy (3d-CRT): 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.
  2. 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.


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 places 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.

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.

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 Victims Advocates today.

View Author and Sources
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Last modified: March 1, 2018