Mesothelioma Radiation Therapy

Quick Summary

Radiation therapy is often used in conjunction with surgery and chemotherapy to treat mesothelioma. Using powerful rays, radiologists can target, shrink and destroy mesothelioma tumors to prevent them from spreading.

Mesothelioma Radiation Overview

Radiation therapy is a standard cancer treatment. For mesothelioma patients, radiation therapy may be used as a standalone treatment, or as part of a multimodal approach to eliminating cancer.

If your healthcare team has suggested radiation therapy, then here is what you need to know about this type of cancer treatment:

  • Radiation therapy uses high-energy rays or particles to directly target tumors
  • Patients undergo an initial consultation so that doctors can know the exact size and location of the tumors they are targeting
  • Radiation therapy is administered by experienced oncological radiologists who know the exact dose of radiation to deliver
  • Patients feel no pain during radiation therapy and there are usually limited side effects
  • Radiation therapy techniques are constantly being refined to ensure optimal effectiveness

What Is Radiation Therapy for Mesothelioma?

Radiation therapy techniques for mesothelioma have come a long way in the past few years. Previous radiation therapy technology wasn’t always best suited for mesothelioma due to how the tumors grow irregularly.

Older radiation therapy couldn’t directly target mesothelioma tumors, but today’s technology can better conform to irregular mesothelioma tumors.

There are several technologies and techniques involved in radiation therapy.  Doctors recommend one radiation approach over another based on many factors, including tumor location, how far it has spread and what other treatment options are available.

Goals of Radiation Therapy for Mesothelioma

Radiation therapy works by sending high-energy rays or particles directly to the tumor site. The rays or particles interfere with the mesothelioma cells’ DNA, which gives the cells signals to grow and divide. By scrambling their DNA, mesothelioma cells can no longer contribute to tumor growth.

Over time, radiation causes tumors to shrink as mesothelioma cells die off when they cannot replicate. By knowing how radiation works, patients can better understand the overall goals of using radiation therapy.

Some of the primary goals of radiation therapy for mesothelioma treatment include:

  • Shrinking tumors
  • Killing remaining cancer cells left behind after surgery
  • Preventing further metastasis
  • Alleviating painful symptoms

Doctors set treatment goals for patients based on how far advanced the mesothelioma is. If the mesothelioma remains relatively localized, doctors will use radiation either before or after surgery to help shrink tumors and destroy remaining cells. If the patient has an advanced case of mesothelioma, then curative surgery is no longer an option. Doctors may instead use radiation in palliative care to help alleviate pain by controlling metastasis.

Radiation Therapy Approaches in Treating Mesothelioma

It’s important for all mesothelioma patients to understand how radiation therapy fits into the overall treatment picture. On its own, radiation therapy cannot eliminate mesothelioma from the body. Instead, doctors use it as a supporting therapy to perform certain aspects of treatment that other methods cannot accomplish on their own.

There are three primary ways that doctors use radiation therapy:

  • Adjuvant Therapy: Adjuvant is a medical term meaning to help after surgery. In some cases, medical teams may decide to use radiation therapy following surgery to help eliminate remaining cancer cells. During surgery, microscopic cells can move around, which puts the patient at risk of developing new tumors. This is known as “seeding”. By treating the patient with radiation therapy after surgery, doctors can eliminate remaining cells and prevent seeding.
  • Neoadjuvant Therapy: When doctors use radiation therapy before surgery, it’s known as neoadjuvant therapy. Doctors have found this to be an especially effective approach in some cases because it allows them to shrink tumors so they are easier to remove surgically. Neoadjuvant radiation also helps to prevent seeding to distant sites during surgery.
  • Palliative Therapy: In cases where patients are experiencing severe pain due to metastasis, doctors will use radiation therapy to shrink tumors and provide relief. The process of treating symptoms to improve quality of life is called palliative care.

Radiation Treatment Update

All mesothelioma radiation treatment plans are 100% personalized to the patient. Mesothelioma experts know that no two cases are alike, and they are firm believers in tailoring treatment plans for optimal effectiveness.

Your team of mesothelioma specialists will use their decades of experience to determine which radiation therapy approach best supports your overall survival.

Types of Radiation Therapy for Mesothelioma

Radiation therapy is a developing technology and new techniques are currently being refined. Doctors use a few different radiation therapy techniques to treat mesothelioma, including external beam radiation and intraoperative radiation.

Ongoing research in clinical trial settings and publications is still determining the best ways to treat mesothelioma using radiation therapy.

External Beam Radiation

The most common radiation therapy technique is external beam radiation therapy (EBRT). In this approach, radiologists use x-ray machines to point radioactive waves directly at tumors from outside the patient’s body.

With EBRT, doctors need to first look inside the patient using imaging scans to see exactly where the tumors are. One way to get a detailed look at the mesothelioma tumors is to use 3D images.

Three-dimensional conformal radiation therapy (3D-CRT), takes a series of 3D images to show doctors the exact shape and size of the tumor. With this information, radiologists can determine the correct dose of radiation to use and where.

Intensity-Modulated Radiation Therapy (IMRT) is another approach radiologists use to administer the correct dosages of radiation.

Based on 3D images of the tumors, doctors use IMRT to administer different amounts of radiation from different directions, allowing doctors administer the most intense levels of radiation directly to the tumor itself while protecting surrounding healthy tissues.

Intraoperative Radiation Therapy (IORT)

In some cases, doctors may choose to administer radiation therapy directly inside the patient while they are undergoing surgery—an approach called intraoperative radiation therapy (IORT). As the surgeon removes the tumor, radiation is then applied directly to that site.

IORT helps in preventing seeding, which can occur when mesothelioma cells move around during surgery. Concentrated and direct radiation doses can be highly effective at eliminating microscopic cells left behind.

The benefit to this approach (as opposed to an adjuvant approach) is that it can minimize the need for follow-up radiation therapy after surgery.

SMART—Surgery for Mesothelioma After Radiation Therapy

The SMART approach to pleural mesothelioma treatment is becoming widely recognized for its impressive results. Surgery for Mesothelioma After Radiation Therapy challenges the conventional approach to radiation treatment, which is normally used as a follow-up therapy after the extrapleural pneumonectomy surgery.

The philosophy behind SMART is that administering radiation therapy before EPP can prevent the seeding of mesothelioma cells to distant sites during surgery. Seeding prevention reduces the chance of mesothelioma recurrence.

Mesothelioma specialists from the Mesothelioma Research Program at Toronto General Hospital conducted a feasibility study on the SMART approach for pleural mesothelioma patients who are candidates for EPP.

Mesothelioma Treatment Update

84% of patients with epithelioid cell type survived 3 years or longer with the SMART approach. These results are extremely encouraging because the overall 3-year survival rate for pleural mesothelioma patients is around 10%.

What to Expect When Undergoing Radiation Therapy

Many patients are understandably concerned about undergoing radiation therapy. Your medical team will help prepare you for radiation treatment and explain what to expect.

Generally, all radiation therapy follows a similar process:

  • Consultation: Radiologists meet with patients to review their case, answer questions and determine the best radiation therapy approach.
  • Imaging Tests: Doctors conduct tests to determine the tumor size, shape and location so they know the safest way to administer the radiation.
  • Treatment Days: Patients arrive at the center and get changed into protective clothing. Treatment lasts up to 30 minutes and is administered 5 days per week for up to 10 weeks.
  • Follow-Up: Doctors monitor patients closely to see how radiation has worked to shrink the tumor. Doctors also check for any potential side effects.

Radiation Therapy Side Effects

Radiation therapy has very minimal side effects and risks compared to surgery or chemotherapy.

Many people incorrectly assume radiation therapy will hurt or that they’ll be able to feel it. Radiation therapy doesn’t hurt, and you cannot feel the rays on your skin. You also aren’t at risk of being radioactive afterward, and it is safe for you to be around others following treatment. You may not feel any effects from radiation therapy.

However, some people do experience side effects such as:

  • Skin reddening at radiation site
  • Hair loss at radiation site
  • Fatigue

If you do experience side effects, they will go away once treatment has stopped. Doctors will continue to monitor any changes in your condition during follow-up appointments.

It’s important to report any side effects to your radiologist immediately so they can alter your treatment plan or take preventative measure against additional side effects.

Improving Mesothelioma Prognosis With Radiation Therapy

Radiation therapy is an important treatment option for many mesothelioma patients. Not only can it help destroy existing tumors, but it can also prevent new ones from forming and effectively minimize the risk of recurrence. Being a safe and non-invasive form of treatment, many patients like the idea of being treated with radiation therapy in conjunction with surgery and chemotherapy.

For patients who are experiencing painful symptoms due to late-stage disease progression, radiation therapy can be an important palliative approach to reducing tumor size and alleviating pain from metastasis.

With ongoing research into the best radiation therapy approaches, doctors are improving the overall treatment landscape for mesothelioma patients. Radiation therapy development is giving patients a better chance at long-term survival.

If you have questions about radiation therapy for mesothelioma, contact one of our Patient Advocates today. Mesothelioma Help Now is here to assist you and give you the information you need to take charge of your health during mesothelioma treatment.

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Sources
  1. American Cancer Society, “Radiation Therapy for Malignant Mesothelioma”. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/radiation.html. Accessed on December 27, 2017.
  2. Cancer Research UK, “Mesothelioma: Radiotherapy treatment.” Retrieved from: http://www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/radiotherapy/treatment. Accessed on December 27, 2017.
  3. Cancer/Radiothérpaie, “Radiation therapy for malignant pleural mesothelioma.”
    Retrieved from: http://www.sciencedirect.com/science/article/pii/S1278321817300057?via%3Dihub. Accessed on December 27, 2017.
  4. Journal of Thoracic Oncology, “A Feasibility Study Evaluating Surgery for Mesothelioma After Radiation Therapy “SMART” Approach for Resectable Malignant Pleural Mesothelioma.” Retrieved from: http://www.thoracic.org/members/assemblies/assemblies/thoracic-oncology/resources/JTO-SMART-2014-article-from-Peikert-2014.pdf. Accessed on December 27, 2017.

Last modified: May 7, 2018