Types of radiation therapy for pleural mesothelioma vary based on how, when, and which method is used. Doctors consider each factor of your diagnosis when selecting the best types of radiation therapy to meet your specific needs.
Radiation Therapy Methods
Radiation treatment differs depending on its purpose or how it's 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 with other treatments like surgery. 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 patients with late-stage pleural mesothelioma.
- Adjuvant: Radiation therapy after surgery is a form of adjuvant therapy. Often radiation is the last step in a trimodality treatment plan. Trimodal therapy uses chemotherapy, surgery, and radiation.
Radiation therapy is a common practice in treating pleural mesothelioma. However, it’s 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 to help patients with 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. Evidence shows that palliative treatments can also help patients cope better with other treatments.
If you are a veteran diagnosed with mesothelioma and are considering the different types of radiation therapy, you may qualify to receive additional benefits from the U.S. Department of Veterans (VA) to help cover the costs of your medical expenses. Request a copy of our free Veterans Packet for details on how to get started.
Radiation Delivery Types
Doctors use different radiation delivery methods for mesothelioma based on what they think will be most successful. The delivery method depends on many factors, such as 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 take X-rays of where 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 2 main types of mesothelioma radiation:
- External beam radiation: This is the most common radiation method. A machine applies radiation, and the process is quick and painless. One type of external beam radiation called intensity-modulated radiation therapy (IMRT) delivers calculated doses of radiation to different parts of the body. The machine moves around the body while adjusting for areas where the mesothelioma is located.
- Brachytherapy: Irradiated implants or “seeds” are surgically implanted near tumors. Brachytherapy only releases limited amounts of radiation to limit side effects.
According to the American Cancer Society, most mesothelioma patients receive radiation therapy 5 days a week for several weeks.
Multimodal Radiation Types
Radiation types differ based on 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 chance 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, people having lung-sparing surgery usually receive radiation after surgery.
Trimodal therapies tested since 1999 showed patients with survival times of 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 case because the lung becomes so irradiated it can cause negative side effects. By removing the lung, the risk of side effects is also removed.
This method has helped some patients live years beyond their initial prognosis. Additionally, neoadjuvant radiation could allow 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 they can see the location of the tumors rather than having to rely on imaging scans.
By far the most common type of radiation therapy, adjuvant radiation, is offered after surgery. Adjuvant radiation can kill mesothelioma cells left behind during 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.
Treatments at Cancer Centers
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.”
Veterans who have been diagnosed with mesothelioma may be eligible to receive additional VA benefits. Request our free Veterans Packet to learn more about these offerings.
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. Only a team of specialists can determine the right radiation type for you.
Key points about types of radiation for mesothelioma include:
- Multimodality therapy, including radiation, offers the best survival times.
- Radiation is useful at any stage of mesothelioma.
Radiation is just one part of mesothelioma treatment. Support and peace of mind are also important factors in achieving a better quality of life. Our staff 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.
Types of Radiation Treatment: Common Questions
What are the types of multimodal mesothelioma radiation?
There are a couple of different types of multimodal radiation therapy.
Neoadjuvant radiation therapy is administered before surgery and has proven effective for late-stage pleural mesothelioma patients.
Adjuvant radiation therapy is applied as the final step in a trimodality treatment plan, which combines chemotherapy, surgery, and radiation. Radiation therapy after surgery is a form of adjuvant therapy.
Does radiation therapy act as a pain reliever?
Radiation therapy can help provide pain relief to mesothelioma patients.
Through palliative radiation therapy, the size of a tumor can shrink, which helps make breathing easier because there is now more space around the lungs and in the chest.
How is radiation therapy applied?
Two common types of mesothelioma radiation are external beam radiation and brachytherapy.
Through external beam radiation, a machine is used to apply radiation quickly and without pain.
The application of brachytherapy involves irradiated implants surgically inserted into the body near tumors. These inserts release limited amounts of radiation to reduce potential side effects.