Radiation oncologists are integral members of multidisciplinary oncology teams that treat mesothelioma. Working in coordination with thoracic surgical oncologists and medical oncologists, these highly skilled specialists create sophisticated therapeutic plans that target and regulate doses of high-energy radiation to kill cancer cells. Radiation oncologists who treat mesothelioma have deep knowledge of the cancer’s biology and patterns of spread, and use it to tailor precise treatments that improve patient outcomes and quality of life.[1]
What is a Radiation Oncologist?
A radiation oncologist is a physician who has specialized training in performing radiation treatment for people with cancer, as well as for some benign conditions. They use their education and expertise to tailor treatment to each patient’s needs, directing radiation to tumors while minimizing the dose of radiation to normal, healthy tissues.
Radiation oncologists’ care is closely tied to innovative technical equipment that allows them to deliver patient-tailored doses of radiation with great precision. Though some believe that radiation’s benefits in mesothelioma care are limited and that radiation is delivered in a standardized manner, each patient’s treatment is entirely customized. For some patients, radiation may be used to try to cure their cancer or to optimize the impact of a scheduled surgery, while for others the goal is palliative, and meant to relieve pain.[2]
How Does a Doctor Become a Radiation Oncologist?
After completing their undergraduate education and medical school, radiation oncology candidates must apply for acceptance into a radiation oncology residency. Radiation oncology is one of the most competitive medical fields to enter: There are fewer than 200 radiation oncology residency positions offered each year in the United States, and only the best and the brightest are chosen for these spots.[3]
Those who are accepted complete a one-year internship which is usually focused on either Internal Medicine or Surgery. The internship is followed by four years of specialty training during which residents gain experience in treating a variety of cancers. Once residency is completed, those who are interested in specializing in treating thoracic cancers or other areas generally complete a fellowship in the use of advanced technologies.[3]
How Do Radiation Oncologists Treat Mesothelioma
Radiation oncologists consult with their colleagues as well as with patients to evaluate treatment options for shrinking the mesothelioma tumors or stopping their metastatic spread. The treatment plan may call for radiation to be used before surgical resection, as the primary local therapy, or post-surgically, but whatever the plan is agreed to, the radiation oncologist will spend hours planning, or mapping, to ensure accurate targeting and focusing of the radiation energy.
Radiation oncologists will often use imaging technologies to help them see where tumors sit in the patient’s body and to help them factor in respiration and movement to ensure greater precision in the delivery of the radiation treatment. These simulation scans, which usually involve CT Scans but are sometimes performed using MRI or PET, arrange and scan patients in the exact position in which they will be treated. They often serve the dual purposes of producing a customized mold to ensure that patients are kept as still as possible during treatment and allowing the radiation oncology team to create a reproducible plan over multiple treatments.[2]
The radiation oncologist will also use the simulation scan to draw on the images of the patient’s internal anatomy, contouring the use of the radiation within millimeters to exactly where the cancer is or where the radiation will be given postoperatively. They also identify surrounding organs and tissues that need to be avoided and calculate heat gradient volumes to optimize the effectiveness of the therapy. Calculating a treatment plan and quality checking the details can sometimes take as long as two weeks, and requires consultation with dosimetrists and medical physicists. The actual treatment delivery is often done with the help of radiation therapists who operate the equipment. Radiation oncologists also rely on nursing staff and other allied healthcare professionals to support patients and help them manage symptoms and adverse effects.[3]
What Technologies Do Radiation Oncologists Use to Treat Mesothelioma?
While radiation therapy was once viewed as strictly being a palliative treatment for malignant pleural mesothelioma, technical advances in radiation therapy equipment have offered greater precision in the delivery and modulation of energy, allowing it to be used without affecting key organs. This has increased its use as an adjunct to surgery, especially as recent research has shown that pleural mesothelioma is sensitive to increases in dose per fraction, or treatment, and that radiation combined with systemic chemotherapy is more effective in patients with mesothelioma.[4]
The two types of radiation therapy that have proven most useful in treating malignant pleural mesothelioma are Intensity Modulated Radiation Therapy (IMRT) and Proton Therapy. Both allow better dose delivery to the tumor while sparing surrounding healthy tissue and organs.[5]
- IMRT is most frequently used to treat the lining around the lungs while protecting the other vital thoracic organs. This technology uses a machine called a linear accelerator that rotates around the patient, emitting a highly targeted external beam of radiation therapy. The radiation oncologist can divide the radiation into many small, computer-controlled beams of different, adjustable strengths and sculpt them into three dimensions that conform to the size, shape, and location of the mesothelioma tumor. This protocol is particularly helpful after extrapleural pneumonectomy to lower the risk of mesothelioma returning.
- Proton therapy is another highly targeted form of radiation therapy that localizes radiation exposure and reduces excess radiation that would otherwise affect the lung, heart, or esophageal tissue in the area, whether it is being used in a postpneumonectomy setting or when the lung is still intact.
Radiation Oncologists Are Researching New Approaches to Mesothelioma
Many radiation oncologists are actively involved in clinical trials to find ways to improve survival and mesothelioma patient well-being. As technology continues to evolve, it is expected that these highly skilled and dedicated medical professionals will continue to play an essential role in the care of patients diagnosed with the rare asbestos-related disease.
