Radiation Therapy for Pleural Mesothelioma

Quick Summary

Pleural mesothelioma is a form of cancer in the lung lining or what’s called the pleural mesothelium. Its sole known cause is from inhaling asbestos fibers. Currently, there’s no known cure for this debilitating disease which can take up to 50 years from the time of asbestos exposure to when symptoms present. However, today’s medical science is making breakthroughs in treating pleural mesothelioma with advanced radiation therapy treatment.

Radiation Therapy for Pleural Mesothelioma Overview

Radiation therapy for treating pleural mesothelioma uses high-energy light beams to attack, infiltrate and destroy cancer cells.

Radiation therapy involves two light photon types:

  1. Gamma Ray spectrum—intense energy and extremely dangerous in large doses.
  2. X-Ray spectrum—less-intense photons similar to what’s used in medical imaging.

Radiation works by scrambling mesothelioma cells’ DNA—causing cancerous cells to lose the biological information necessary for the ability to multiply.
Cells are the basic building blocks that construct every part of human existence. Cancerous cells are those that turn rogue. Rather than normal division and timed death (apoptosis), which is how healthy cells operate, cancerous cells don’t die off when they’re supposed to. They multiply at an alarming rate and create tumorous life forms of their own. When radioactive waves interact with cancer cells, they’re unable to survive, and the tumor shrinks.

Western medical science began using radiation therapy many years ago. The first experiments with radiating people occurred in the late 1800s. There have been major technological advancements in the 21st century, using cutting-edge radiation therapy techniques—especially in treating pleural mesothelioma. Radiation therapy and inclusive multimodal interventions like surgery and chemotherapy can’t yet cure mesothelioma. However, these treatments allow a much better chance of managing a patient’s disease and offer them longer survival rates.

What Is Radiation Therapy for Pleural Mesothelioma?

Radiation therapy, or radiotherapy, is used for many cancer forms including pleural mesothelioma. On its own, radiation therapy administered by radiation oncologists has limited effect on treating cancer. Radiation is part of a treatment plan and is used in conjunction with surgery. That can be before surgical intervention, during the surgical procedure or after surgery is complete and the patient is healing.

Before-surgery treatment is known as neoadjuvant radiation therapy and post-surgical radiation treatment is simply called adjuvant therapy. The word “adjuvant” comes from the Latin term “to help”. That accurately describes radiation, as the process is designed to help an overall treatment plan developed by a multidisciplinary medical team.

These are the three main modes of pleural mesothelioma intervention:

  • Surgery: Surgically removing a pleural mesothelioma tumor is a drastic and invasive step. Often, surgical options aren’t practical in pleural mesothelioma cases, as the tumor is too large or too widespread. In suitable situations, surgical oncologists employ two tumor removal methods. One is extrapleural pneumonectomy (EPP) where the diseased lung and lining is removed. The other procedure is pleurectomy with decortication (P/D) where only the diseased pleural portion and surrounding cancerous tissue is taken out.
  • Chemotherapy: Intervention through chemotherapy is done with chemicals. Special medications introduced by intravenous injection or oral application infiltrate the patient’s bloodstream and attack cancerous cells from inside the body. Chemotherapy is notably effective in controlling pleural mesothelioma cells when used in an early stage. Chemotherapy slows cancerous cell production and gives time for the medical team to introduce other measures like surgery and radiation therapy.
  • Radiation Therapy: Radiotherapy is a focused action directly targeting a tumor or pleural areas affected by mesothelioma. It’s a painless procedure and the least invasive component of a multimodal treatment program. Radiation therapy is localized or aimed at precise tissue in defined areas. Normally, radiation treatments are done once per day for a week or two. That depends on whether used adjuvant or neoadjuvant.

What Are the Goals for Radiation Therapy for Pleural Mesothelioma?

Goals for pleural mesothelioma radiation therapy vary depending on a number of factors, including:

  • Tumor location
  • Mesothelioma stage
  • Mesothelioma cell type
  • Patient’s general health
  • Patient’s unique multimodal plan

In general, these are goals set for radiation therapy for pleural mesothelioma:

  • Shrinking Tumors: While radiation isn’t yet individually effective at eradicating pleural mesothelioma tumors, radiotherapy is proven to reduce or shrink tumor size. Using radiation therapy before surgery (neoadjuvant) allows tumors to minimize to the point where surgical removal is easier.
  • Killing Remaining Microscopic Cancer Cells: It’s extremely difficult, if not impossible, for surgical oncologists to remove all pleural mesothelioma cells. Most tumors are widespread, and there’s a blurry line where the mesothelium divides from the lungs and other organs. Radiation therapy applied adjuvantly can be highly effective in killing remaining cells only visible with a microscope.
  • Preventing Seeding: Transferring infected cells during surgical operations is called seeding. Incision edges are especially vulnerable for contamination with cancer cells moved from their original location and being imbedded or seeded into fresh areas. Radiation can catch seeded cells immediately after placement and stop them from taking hold in a new spread.
  • Palliate Symptoms: Palliative care refers to easing a patient’s symptoms associated with pleural mesothelioma and other cancer forms. Often, late-stage mesothelioma patients suffer pain and other discomforts while the disease progresses. Radiation therapy works to reduce active cancer cells in expanding tumors thereby reducing symptoms during palliative care.

Radiation for Pleural Mesothelioma Approaches

Employing radiation therapy for treating pleural mesothelioma has different approaches. This depends on the particular patient, their condition and what technologies the treatment team is familiar with. It’s fair to say that technology is rapidly changing for pleural mesothelioma treatment. Currently, an experienced mesothelioma multidisciplinary team will use one of four effective radiation treatment approaches.

  • Adjuvant radiotherapy has been the commonest radiation treatment approach. It’s used after surgery and during the follow-up period.
  • Neoadjuvant radiation therapy begins before any surgical procedure starts. The idea is to slow tumor progression or shrink it prior to physical intervention like EEP or P/D.
  • Intrapleural intervention employs radiation therapy techniques that directly enter the pleura. That can be done by open surgery or robotic placement of radioactive treatment devices.
  • SMART is the acronym for Surgery for Mesothelioma After Radiation Therapy. It’s only effective when removing the entire lung with the EPP procedure, as the amount of radiation dose given during the accompanying Intensity-Modulated Radiation Therapy (IMRT) destroys the entire lung.

How Is Radiation Therapy for Pleural Mesothelioma Administered?

Radiation therapy for pleural mesothelioma is administered to the patient either externally or internally. External radiation is the oldest method and is the least invasive. Internal radiation therapy requires a device being surgically implanted. Each administration form has its pros and cons.

  • External Beam Radiation Therapy: Intense radiation beams sent from a machine enter a patient who is conscious and not anesthetized. New advancements in external radiation therapy techniques include Intensity-Modulated Radiation Therapy (IMRT), where radiation doses are tightly controlled, and the three-dimensional 3-D Conformal Radiation Therapy (3D-CRT) where beams are sent from multi-angles.
  • Brachytherapy: Involves placing radioactive substances inside the patient’s body next to the tumor. These are prescribed doses peculiar to the patient’s needs and can be temporary or left permanent. Direct and robotic surgical procedures apply.

What Are the Results of Radiation Therapy for Pleural Mesothelioma?

Radiation therapy for pleural mesothelioma shows promising results for improving patient survival periods and better comfort with a gain in quality of life. Each year, oncologists and their multidisciplinary team increase their understanding of how to apply radiation therapy. Pleural mesothelioma patients can have their lives extended by a number of years—up to 5 years with treatment approaches like SMART—thanks to dedicated researchers who conduct clinical trials using radiation technology.

Possible Side Effects of Radiation Therapy for Pleural Mesothelioma

Radiation therapy side effects vary from patient to patient and between what approach and administration the treatment team uses. Most patients report limited discomfort from external radiation. Often, it’s not more than a sunburn feeling on the radiation point of entry. Brachytherapy patients may have a more adverse reaction. They report flu-like side effects including drowsiness, headache, nausea and weakness.

Seeking Radiation Therapy for Pleural Mesothelioma

Most pleural mesothelioma treatment teams involve their patients in developing their treatment plan. These specialists know how to assess a patient’s personal needs. That includes listening to their patient and discussing various options. From there, oncology professionals decide what form of radiation therapy to use in the treatment plan and when to use it.

For more information on radiation therapy for pleural mesothelioma, contact our Patient Advocates today.

View Author and Sources

  1. U.S. National Institute of Health, “What is the Role of Radiation Therapy in Pleural Mesothelioma Treatment?”, Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228097/  Accessed on February 21, 2018
  2. Texas Oncology, “Radiation Therapy for Pleural Malignant Mesothelioma”, Retrieved from https://www.texasoncology.com/types-of-cancer/mesothelioma/radiation-therapy-for-malignant-pleural-mesothelioma  Accessed on February 21, 2018
  3. National Cancer Institute, “Radiation Therapy for Cancer”, Retrieved from https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy  Accessed on February 21, 2018

Last modified: April 4, 2019