Radiation therapy for pleural mesothelioma varies based on how, when and what method is used. Doctors consider each factor of your diagnosis when choosing the best type of radiation for you.
Mesothelioma Radiation Therapy Methods
Radiation treatment is different depending on its purpose or how its administered. Some patients receive radiation after surgery while others have it before. The end goal of radiation can range from radical tumor shrinkage to simple pain relief. Often radiation is used to make surgery more successful. This is known as multimodal therapy.
Here are types of multimodal radiation therapy:
- Neoadjuvant. This involves the use of radiation therapy before surgery. This method has shown promising results for late-stage pleural mesothelioma patients. Researchers are studying the use of neoadjuvant radiation.
- Adjuvant. Often radiation is the last step in a trimodality treatment plan. Trimodal therapy uses chemotherapy, surgery, and lastly, radiation. Radiation therapy after surgery is a form of adjuvant therapy.
Radiation therapy is a common practice in treating pleural mesothelioma. However, it’s very rarely used to treat peritoneal mesothelioma.
Radiation Therapy for Pain Relief
Another type of radiation therapy is called palliative radiation. The goal of palliative radiation therapy is not curing a patient’s disease, but pain management.
Some patients in the latest stages of mesothelioma have few treatment options that can meaningfully improve their prognosis. Treatment is still important to maintain a comfortable quality of life. Radiation is common because it’s noninvasive and takes relatively little time.
Palliative radiation works by reducing tumor size in the chest. When tumors are shrunk, it’s easier to breathe because there is more space in the chest for the lungs to expand. There is evidence that palliative treatments can also help patients cope better with other treatments.
Types of Radiation Delivery
Doctors use different delivery methods for mesothelioma based on what they think will be more successful. The method of delivery depends on many factors, such as your stage and cell type. But radiation delivery mostly boils down to where your tumors are located.
The standard delivery method of radiation for mesothelioma is to shoot X-rays where to tumors are located. Doctors use imaging scans to ensure they aim the radiation directly at the tumors. A less common delivery method uses irradiated implants.
There are 3 main types of mesothelioma radiation:
- External beam radiation. This is the most common radiation method, it uses a machine to apply radiation. The process is quick and painless.
- Intensity-modulated radiation therapy (IMRT). This type of radiation uses a more advanced machine. IMRT delivers calculated doses to radiation to different parts of the body. The machine moves around the body while adjusting for areas where the mesothelioma is located.
- Brachytherapy. This is the method that uses irradiated implants. These “seeds” are surgically implanted near tumors. The brachytherapy only releases limited amounts of radiation to limit side effects.
Most mesothelioma patients receive radiation therapy 5 days a week for several weeks, according to the American Cancer Society.
Types of Multimodal Radiation
Radiation types differ based on the when the patient receives therapy with respect to surgery. The most common method is for patients to receive radiation after surgery. But patients may receive radiation before or during surgery. Each type has different pros and cons.
Multimodal treatment offers the best chances of survival for mesothelioma patients.
The appropriate radiation method for you depends on your diagnosis. For example, intraoperative radiation therapy isn’t used for peritoneal mesothelioma patients. Your disease stage, cell type and age are other factors that your doctor will evaluate.
Your doctor may choose your radiation type depending on the type of surgery you’re eligible for. For example, those having a lung-sparing surgery usually receive radiation after surgery.
Trimodal therapies tested as far back as 1999 showed patients with survival times up to 51 months. These patients had a combination of surgery, chemotherapy and radiation therapy. The patients with these remarkable survival times had a diagnosis specifically beneficial to this therapy. They had epithelioid cell type, successful surgery and their cancer had not spread to lymph nodes.
Radiation before surgery helps shrink tumors, making surgery more feasible. If tumors are smaller, surgeons have a better chance of removing more of the cancer.
In 2014, doctors tested a new method for neoadjuvant radiation. They used large doses of radiation before an extrapleural pneumonectomy (EPP) surgery. An EPP is the best option in this scenario because the lung becomes so irradiated it can cause negative side effects. By removing the lung, the risk of side effects is removed as well.
This method has helped some patients live years beyond their initial prognosis. Additionally, neoadjuvant radiation could be a chance for late-stage patients to become surgical candidates.
Intraoperative radiation can be paired with the pleurectomy with decortication (P/D) or EPP. P/D is the lung-sparing surgical option for pleural mesothelioma. During surgery, doctors can theoretically target cancerous cells more easily. This is because doctors can see the location where tumors were rather than relying on imaging scans.
By far the most common type of radiation therapy, adjuvant radiation is given after surgery. Adjuvant radiation can kill mesothelioma cells left behind from surgery. This type of radiation method has been used in multimodal mesothelioma treatment since the 1990s. This is because it has been proven to be a successful way of prolonging patient lives.
The goal of adjuvant radiation is for patients to extend their progression-free survival (PFS). PFS is the amount of time a patient shows no signs of mesothelioma regrowth. A study of IMRT after P/D showed patients had a PFS of 1 year.
A 2017 report by Dr. Marc dePerrot tested the median survival times of patients who had adjuvant IMRT after EPP. DePerrot found that median survival reaches 23 to 39 months independent of chemotherapy, so even without chemotherapy added, patients could triple the average survival time by having IMRT after an EPP.
Importance of Mesothelioma Cancer Centers for Radiation
All in all, specialization is the key to appropriate radiation treatment. A 2017 review compared the success of neoadjuvant and adjuvant radiation. Doctors reported that, “Individualization of care for each patient is fundamental in choosing the most appropriate treatment.” Rather than choosing the best radiation type, doctors must look at the individual’s condition.
The doctors of the 2017 review further stressed the importance of mesothelioma patients visiting a mesothelioma cancer center. These cancer centers have specialists in all fields of mesothelioma treatment. Multidisciplinary teams are best at creating a successful multimodal treatment plan.
Most patients with pleural mesothelioma benefit not only from radiation and surgery. According to doctors, patients have “better results reported for trimodality approaches.”
Which Radiation Type Is Right for You?
The best way to control your prognosis is to see a mesothelioma specialist. Radiation treatment for mesothelioma is becoming more advanced as treatments become more effective. This is because doctors work as a team to tailor each part of treatment, including radiation, exactly for your diagnosis. Only a team of specialists can determine the right radiation type for you.
Key points about types of radiation for mesothelioma include:
- Multimodal radiation offers the best survival times.
- Radiation is useful at any stage of mesothelioma.
- Mesothelioma cancer centers have the best radiation teams.
Radiation is just one part of mesothelioma treatment. Support and peace of mind are also important factors to a better quality of life. There are people who can help you find the treatment you need and ways to pay for it. Veterans have many of the best resources for mesothelioma treatment. Talk to one of our VA-accredited representatives about your benefits today.