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Radiation therapy, also sometimes called radiotherapy, is a common cancer treatment strategy. Mesothelioma radiation therapy is one of three main treatment techniques used to battle this aggressive type of cancer. The other two are surgery and chemotherapy. Radiation therapy may be used alone, but is more often used as part of a multimodal treatment approach along with chemotherapy, surgery, and other treatments.

For mesothelioma, radiation therapy is typically used to destroy cancer cells left in the body after surgery to remove tumors. It is also used to shrink tumors as a palliative treatment. The use of radiation involves harmful, high energy rays to kill cells, but it is targeted at cancer cells. There may be some side effects, but they are typically less severe than those associated with chemotherapy.

What is Radiation Therapy?

This type of therapy, which is used for various types of cancer, not just mesothelioma, uses high energy radiation to kill cancer cells. The radiation may be X-rays or gamma rays, as well as high energy charged particles. These high energy particles and rays kill living cells by damaging the DNA, or the genetic material. When DNA is badly damaged a cell will stop growing and dividing. The dead cell is then broken down and recycled or eliminated from the body through natural processes. Radiation kills all cells, not just cancer cells, but radiotherapy is given in a way that is targeted to minimize the death of healthy cells.

External Radiation Therapy

Radiation therapy can be used in one of three ways: externally, internally, and systemically, depending on how it is applied to the patient. External radiation involves using a machine that creates a beam of radiation and aiming that beam at the part of the body in which the cancer has been found. The actual procedure is painless and is a lot like getting an X-ray. There are several different variations on external radiation therapy.

One of these image-guided radiation therapy, which uses CT scans or MRI images to target the tumor in the body and aim the radiation beam. Three-dimensional radiation uses these images, but pieces them together to give an even clearer picture of where the tumor is. It helps to minimize the exposure of healthy tissue to radiation. Intensity-modulated radiation is administered in varying bursts of intensity. This allows the treatment to better target the exact size and shape of the tumor, again minimizing harm to healthy cells.

Systemic Radiation Therapy

Systemic radiation therapy is a different way of targeting tumor cells with radiation. Instead of using an external beam, radioactive drugs are used to deliver radiation systemically, throughout the whole body. These drugs can be given intravenously or orally. The radioactive drug is typically attached to an antibody that targets cancer cells so that the radiation is not delivered to all cells in the body. The radioactive material accumulates in the tumor where it can kill cancer cells.

Brachytherapy

Brachytherapy is another type of internally-delivered radiation therapy used to treat mesothelioma and other types of cancer. To use this treatment strategy, a radioactive substance is placed within an implant, which is then surgically placed inside the body, next to the tumor. Here the material will emit radiation to kill cancer cells. The benefit of this type of radiation therapy is that, although it is invasive, it allows for a higher dose of radiation to be targeted at a small area in the body.

Brachytherapy implants may be placed permanently, which is called seeding or seed implantation, or temporarily. The radioactivity, or the radiation emitted by the material in the implant, diminishes over time, so permanent placement does not mean that a patient will have radiation inside of them forever.

Mesothelioma Radiation Therapy as Curative

There are two possible goals in using radiation therapy in patients with mesothelioma. One is as part of an overall treatment plan that it is hoped will be curative. In people with earlier stages of mesothelioma, before the cancer has spread very far from the pleura or peritoneum, a cure is considered unlikely, but not impossible. Aggressive treatment that includes radiation gives these patients a chance at eliminating the cancer.

The most common way that radiation is used in mesothelioma is after surgery. Surgery is the best way to attempt to cure early stage mesothelioma. It is used to remove as much of the cancer as possible. After surgery, radiation is used to destroy any remaining cancer cells and to reduce the risk that the cancer will return. Mesothelioma cancer cells are particularly sensitive to radiation, but using this as the lone treatment is not usually possible because the nearby organs—the lungs, heart, and spinal cord—are also sensitive to radiation. Doses of radiation high enough to cure mesothelioma cause too much damage to these other tissues.

Even when a multimodal treatment approach that includes radiation cannot cure mesothelioma, it is successful at extending the life expectancy of early stage patients. One study showed that life could be extended by nearly three years in patients who underwent radical surgery followed by high doses of radiotherapy.

Radiation Therapy for Palliative Care

The other reason to use mesothelioma radiation therapy is to relieve pain or reduce other symptoms of cancer by shrinking the size of tumors. Radiation therapy has been shown in research to reduce the pain of patients with pleural mesothelioma. By reducing the size of the tumor, pressure on the lungs and pleura is reduced. In other types of mesothelioma, radiation can have a similar palliative effect.

Side Effects of Mesothelioma Radiation Therapy

Because radiation therapy is usually targeted, side effects are typically not as severe as with other treatments like chemotherapy. The targeting is not perfect, though. For instance, an external radiation beam has to go through the skin, which means that skin side effects are common. These include redness, irritation, burning, blistering, hair loss, and extended dryness, peeling, and itchiness.

Another common side effect of radiation therapy is fatigue, which mostly sets in after a couple of weeks of radiation therapy. Other potential side effects include low white blood cell and platelet counts, which can cause infections and bleeding. Eating difficulties are also common, especially with radiation therapy for peritoneal mesothelioma.

With radiation therapy there is also a risk that the radiation will cause long-term damage to organs near the site of the tumor. With mesothelioma, this especially puts the lungs and heart at risk. There is also a possibility that radiation treatment increases the risk of developing another cancer later on. With mesothelioma, though, a patient’s life expectancy is already limited, so this is not often a concern.

Weighing Benefits and Risks

The idea of getting radiation therapy can be frightening, considering the potential risks and side effects. As with any medical treatment, it is important to weigh the benefits against the risks. Benefits include potentially curing the cancer or extending life expectancy and reducing pain. Risks include feeling fatigued and getting infections or even developing another type of cancer.

If you have been diagnosed with mesothelioma, you have to weigh the benefits against the risks along with the advice of your medical team and the support of your loved ones. Considering how aggressive mesothelioma is, radiation as an aggressive treatment makes sense for most patients, in spite of side effects.

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