Managing Side Effects From Mesothelioma Radiation

Quick Summary

Radiation therapy may be the best or only option for mesothelioma, and while every person reacts differently, side effects generally start presenting within a few days of beginning treatment.  

How Does Radiation Cause Side Effects?

Radiation therapy uses high-energy x-rays and other particles to destroy cancer cells with several treatments scheduled over a set period of time. Chemotherapy, immunotherapy and targeted radiation therapy are all forms of anticancer therapy that work to stop cancer cells from multiplying or by boosting the body’s natural ability to fight them off.

Introducing high-energy particles or waves inside the body to destroy the cancer cells is usually a local treatment.

Although it’s aimed at one part of the body, radiation, in general, is given externally using machines that aim rays at the tumor site, causing a reaction to surrounding tissues, regardless of if they are cancerous or not.

Common side effects of external radiation include:

  • Hair loss
  • Fatigue
  • Sunburn-like symptoms on the skin

Chest radiation therapy may cause shortness of breath, trouble breathing and, in severe cases, lung damage. Abdominal radiation therapy may cause loss of appetite, nausea, diarrhea, and vomiting.

Of course, radiation in combination with any other treatments (chemotherapy, for instance) may produce worse side effects. Adverse reactions generally start a few days after treatments begin and gradually worsen throughout.

While everyone reacts differently to radiation therapy with varying symptoms, side effects typically improve about 2 weeks after treatment begins.

Types of Radiation Side Effects

Treatment and radiation options vary depending on the stage of the cancer and where it’s located.

Below are several ways to treat mesothelioma subtypes.

Pleural Mesothelioma

Pleural mesothelioma is a cancerous tumor that grows in the pleura. Radiation therapy tends to shrink the tumors to assist in pain relief for many patients.

Side effects of pleural mesothelioma radiation treatments can come in 2 stages:

  1. Early-Stage: Typically occur during or right after treatments, with the most common including skin problems, fatigue, and physical reactions in the skin around the injection site.
  2. Late-Stage: Rare but can sometimes be permanent and usually appear months or even years after radiation therapy is completed. Lymph node calcification, fibrosis, or lung tissue scarring may occur in these rare cases.

Other common early stage side effects of pleural mesothelioma may include:

  • Burning near site of injection
  • Hair loss
  • Fatigue
  • Nausea
  • Esophagitis

While rare, late-stage side effects may include:

  • Radiation pneumonitis: Radiation-induced lung disease causing inflammation. This happens in 5-5%of patients that received high-dose external beam radiation.
  • Cardiac radiation damage: Radiation damage to the heart.
  • Liver radiation damage: Radiation damage to the liver.
  • Radiation myelitis: An irradiated spine that causes damage or complications in patients.
  • Pleural effusion: A build up of fluid between the chest and the lungs between layers of tissue lining the lungs and chest cavity.

In some cases, radiation therapy for pleural mesothelioma may be recommended with other drugs or surgery.

Two main surgeries can also be utilized to help curb cancerous cells:

  • Pleurectomy with Decortication: Removes the cancerous lining around the lung as a reduction technique.
  • Extrapleural Pneumonectomy: A more aggressive and challenging form of surgery that can be utilized to remove the entire lung, the lining of the lung, a portion of the lining around the heart, or a portion of the diaphragm.

Peritoneal Mesothelioma

Peritoneal mesothelioma settles in the peritoneum (a thin membrane surrounding the abdomen), and patients often have tumors through the entire abdomen region. Removing these tumors is extremely difficult due to their nature of being spread out rather than clustered together.

Radiation therapy can be used for treatment purposes, but since the clusters tend to grow spread out rather than in an isolated area, targeting them with radiation can be difficult. New radiation therapies are in use and being developed to help navigate this problem.

For patients with peritoneal mesothelioma that are treated with radiation therapy, common side effects may include:

  • Fatigue
  • Sunburn-like skin problems
  • Hair loss
  • Damage to the lungs
  • Trouble breathing or shortness of breath
  • Nausea or vomiting
  • Loss of appetite
  • Diarrhea

If radiation therapy is combined with chemotherapy treatment, the side effects are often worse. Talk with your doctor if you experience any side effects from radiation therapy.

Measures can be taken to help alleviate these symptoms and improve your quality of life while undergoing treatment and after treatment is completed.

Radiation Approaches That Minimize Side Effects

Any form of treatment for mesothelioma patients will take a toll on the body and doctors are dedicated to helping reduce and relieve any side effects that will make treatment seem harder than it has to be.

Minimizing the side effects for patients is a main goal for all doctors. It not only improves the quality of the patient’s life, but it also makes them healthier and better able to fight the cancer.

Healthcare professionals and researchers are always searching for ways to decrease side effects for patients and develop more effective and targeted radiation therapy approaches to further improve survival rates. Talk with your doctor about any new advances or studied in this area.

Some recent advances have helped radiation oncologists minimize the side effects of radiation therapy by developing technology that focuses on laser-targeting the location of scattered tumors with varied-intensity burst wavelengths of visible and invisible light.

Advancements in locating the scattered tumors and excluding the surrounding healthy tissue will help to minimize extra damage to areas that would otherwise be included in treatment and add to the severity of the side effects by targeting healthy tissue along with cancerous growths.

IMRT (Intensity Modulated Radiation Therapy)

An advanced form of 3-dimensional radiation therapy that moves around the patient while delivering a computer-driven treatment. IMRT specifically shapes the radiation beams to fit the tumor and aim those beams directly at it from several angles. The use of adjusting intensity limits the dose of radiation that would reach any healthy tissue nearby.

3D CRT (Conformal Radiotherapy)

A treatment designed to spare the surrounding tissues and organs from radiation while delivering a high and conformed dose directly within the tumors based on CT and/or MRI scans. Based on scans, elaborate plans are created to carry this method of treatment out. This technique is used primarily in patients with tumors that have been considered too close to other vital organs for other courses of radiation therapy.

SMART (Surgery for Mesothelioma After Radiation Therapy)

A new method of treating mesothelioma includes giving patients an accelerated high dose of radiation just before surgery (extrapleural pneumonectomy or EPP) and is only used by a few cancer centers around the world. Ongoing studies suggest a higher survival rate for patients with no lymph node involvement, which is double the average rate for current treatments. This method is still under study and under debate in the medical sphere.

So far, the SMART approach has shown to improve the odds of removing cancerous growths and cells or keeping them from continuing to grow.

In some studies, long-term survivors are most often patients that have undergone surgery of some form during treatment. In using this technique to minimize cancerous cells, the benefits of experiencing more severe side effects are minimized by limiting the dose of drugs or radiation that patients receive.


A source of radiation is placed inside the body, directly in or near the cancerous growth. Since this form of radiation only travels a short distance, the damage to nearby healthy tissues is minimal. Brachytherapy is rarely used for mesothelioma.

Preventing and Managing Radiation Side Effects

While under treatment, certain medications can be used to offset some side effects such as nausea or diarrhea. Specific exercises may also help, while under specialist care, to prevent stiffness or aching in the shoulder or chest.

Healthy living practices and holistic medicine may also help prevent and manage side effects.

Talk with your doctor about how to anticipate side effects ahead of time to prevent them and manage them, and it is important to speak with your doctor before starting any alternative measures (some combinations are harmful based on certain treatments).

Other natural methods of helping manage side effects may include:

  • Getting enough sleep
  • A special diet
  • Herbal supplements
  • Eating plenty of fruits and vegetables

Before trying any natural remedies, make sure to consult your doctor as some natural ingredients may hinder your body’s response to radiation treatments.

Reporting Radiation Side Effects

Before starting radiation therapy, it’s critical to ask your doctor about potential side effects and ways to counter them.

If you or a loved one think you’re experiencing side effects, our Mesothelioma Help Now Patient Advocates are available and ready to answer any questions you have about radiation or its side effects.

View Author and Sources

  1. ACSO, “Mesothelioma: Treatment Options.” Retrieved from: Accessed on January 19, 2018.
  2. Cancer Research UK, “Mesothelioma: Side Effects.” Retrieved from: Accessed on January 18, 2018.
  3. American Cancer Society, “Radiation Therapy for Malignant Mesothelioma.” Retrieved from: Accessed on January 21, 2018.
  4. American Cancer Society, “Radiation Therapy Basics.” Retrieved from: Accessed on January 21, 2018.
  5. Weill Cornell Medicine: Radiation Oncology, “3D-CRT.” Retrieved from: Accessed on January 18, 2018.
  6. Medscape, “Treatment for Radiation Pneumonitis.” Retrieved from: Accessed February 19, 2018.
  7. American Cancer Society, “Treating Malignant Mesothelioma.” Retrieved from: Accessed February 19, 2018.
  8. UCLA Health, “Recent Treatment Advances.” Retrieved from: Accessed February 19, 2018.

Last modified: April 4, 2019