Side Effects of Mesothelioma Radiation Therapy

Common side effects of mesothelioma radiation therapy include skin rashes and fatigue. Side effects for pleural mesothelioma patients include difficulty swallowing and pneumonitis. Peritoneal patients may experience nausea, vomiting, diarrhea, or incontinence.

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What Is Radiation Therapy?

Radiotherapy uses a beam of high-energy radiation to target and kill cancer cells. A machine produces X-rays, gamma rays, or other types of radiation and focuses this energy in a concentrated beam aimed at the tumor.

Radiation therapy is one of three main approaches to cancer treatment, which also includes surgery and chemotherapy. It is not uncommon for patients to undergo a combination of these strategies during treatment. Radiation therapy is most often used after surgery, but doctors may use it before a procedure in some cases.

Types of Radiation Therapy

External beam radiation is the traditional way of delivering radiation therapy. An external beam penetrates the skin and other tissue to reach the cancerous tissue. In the process, the radiation can damage healthy tissue as much as cancerous tissue.[1]

• Brachytherapy. More advanced radiation techniques attempt to avoid this problem. One innovative strategy implants small, radioactive devices near tumors in the body, limiting the area affected by the radiation.[1]

• Intraoperative Radiation Therapy. This is a technique used when a patient is undergoing surgery. The surgeon implants a radioactive device during a procedure to remove tumors.

• Intensity-Modulated Radiation Therapy. This type uses imaging scans and computers to modulate the radiation beam to conform to the tumor’s exact shape. This minimizes the radiation’s effect on healthy tissue.

These techniques reduce side effects; although, any radiation procedure may cause some common side effects, regardless of the part of the body targeted.

Radiation Treatment for Mesothelioma

Radiation therapy is not a primary treatment for mesothelioma, but oncologists sometimes use it before or after other treatments.

Called multimodal treatment, a combination of therapies is the most common approach to treating mesothelioma. A patient might receive radiation before or after surgery or chemotherapy. It can also be used to shrink tumors as part of palliative care.

Common Radiation Therapy Side Effects

Side effects of radiation can vary depending on where on the body it is delivered. However, there are also common side effects that many patients experience regardless of cancer type and location. The two most common side effects of radiation are fatigue and changes to the skin.

Fatigue

Fatigue is one of the most common side effects associated with radiation therapy.[2] This tends to be cumulative, meaning the more radiation you receive, the more fatigue you may have. This can be especially noticeable if patients have a lengthy surgical recovery and then proceed to radiation.

A healthy sleep routine and gentle activity can help. Energy levels will improve following radiation but may take several weeks to do so. In the meantime, patients are encouraged to get help from loved ones, rest as much as possible, and reduce stress.

Skin Irritation at the Treatment Site

Side effects on the skin are also common with radiation. The skin is affected as the radiation beam penetrates on its way to the tumor. Symptoms include:

• Dryness
• Itches
• Peeling skin
• Swelling
• Irritation
• Redness
• Blistering

Most of these will heal after treatment is completed. However, the skin may remain permanently sensitive or discolored in some cases. Patients may also see hair loss at the treatment site; although, it usually grows back in time.[2]

Low-Blood Cell Count

Although rare, radiation may reduce the amount of white blood cells and platelets in the bloodstream.[3] White blood cells are part of the immune system, and reduced counts can result in increased infections.

Platelets are important in clotting. When platelet counts are low, there is an increased risk of bleeding. Lowered platelets and white blood cells are more common when patients are also being treated with chemotherapy.

Pleural Mesothelioma – Side Effects from Radiation to the Chest

For mesothelioma, radiation treatment targets the chest cavity to treat pleural mesothelioma or the abdomen to treat peritoneal mesothelioma. Some side effects are specific to radiation aimed at the chest cavity:[3]

• When the radiation field includes the esophagus, swallowing pain or difficulty may be an issue temporarily. In turn, this can contribute to malnutrition or weight loss. Patients should avoid foods that irritate the throat and eat soft foods and liquid foods such as nutritional shakes.

• Radiation to the chest may also cause inflammation in the lungs resulting in a condition called radiation pneumonitis. Symptoms include difficulty breathing, coughing, and shortness of breath. In some cases, however, this condition can be severe, permanently damaging, and even fatal.

• Approximately one in ten patients will experience chronic pneumonitis as a result of chest radiation. This can be a serious risk for someone with pleural mesothelioma receiving radiation after an extrapleural pneumonectomy, as these patients are left with just one lung. Radiation may also damage the heart, which can be serious and fatal, although rare.

Peritoneal Mesothelioma – Side Effects from Radiation to the Abdomen

Patients undergoing peritoneal mesothelioma radiation treatment to the abdomen can also cause specific side effects These include nausea, vomiting, and diarrhea.[3]

Common with abdominal radiation treatment, these uncomfortable side effects are not usually severe and subside after treatment. Patients can use drugs and dietary changes to ease diarrhea and nausea. Staying hydrated is important, especially with diarrhea.

The bladder may be affected by radiation in the abdominal cavity, resulting in bladder inflammation, blood in the urine, or incontinence. These side effects can be uncomfortable, inconvenient, and even painful. Urination may be accompanied by burning and stinging. Medications and other treatments may help relieve these side effects.

Abdominal discomfort is also a common side effect of abdominal radiation. The pain may be caused by several factors, including infections, cramps in the bowels, constipation, or damage to the pelvic bones. Pain after radiation may also indicate a cancer resurgence. Medications or treatment of the underlying causes of pain can help.

How Long Do Radiation Therapy Side Effects Last?

For most people, the side effects of radiation decrease over time after treatment stops.[4] It may take a week or up to a couple of months to feel better.

• Unfortunately, radiation therapy can sometimes cause long-term damage. The skin in the area where radiation is administered may be permanently changed. The texture, color, and amount of hair may never return to normal.

• Radiation, especially to the abdomen, can potentially cause fertility issues that may be irreversible. Before beginning radiation treatment, patients may choose to freeze eggs or sperm for later use. This is especially important for younger patients.[1]

• Radiation treatment to the chest or abdomen can potentially result in long-term damage to the lungs. This damage can cause permanent breathing difficulties, narrowing of the esophagus, and damage to the bowels or bladder, leading to incontinence or ongoing gastrointestinal issues.

• Another long-term risk associated with radiation therapy is secondary cancer. Radiation applied to healthy tissue can cause cancer. For mesothelioma patients, this isn’t usually a concern. Mesothelioma is often terminal, so the benefits of treatment are worth the risk.

Minimizing the Risk of Side Effects from Radiation

While advances in radiation therapy are reducing side effects, they are not entirely eliminated. Side effects are especially a risk for traditional, external beam radiation. Risks are less for intensity-modulated therapy or brachytherapy.

A recent innovation in radiation therapy is the use of an upright chair during treatment. Patients typically lie down for radiotherapy. A cancer care company in the United Kingdom developed this chair to reduce side effects.[5]

Radiation penetrates further into healthy tissues when a patient is lying down. The simple solution of remaining upright might reduce side effects in some patients.

Doctors are also careful to use the minimum amount of radiation necessary to treat each patient. This is the level of radiation that will provide benefits but minimize side effects.

Radiation for mesothelioma is not standard, but if you need it, understand the risks and minimize them. Be sure to express any concerns or questions to your doctor before beginning treatment.

Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP

Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.

Connect with Doctor of Nursing Practice Anne Courtney