Key Takeaways
- Radiation therapy uses high-energy X-rays or charged particles to kill cancerous cells. Unlike chemotherapy (which affects the entire body), radiation specifically targets the area where the cancer is located.
- Radiation for mesothelioma is challenging because the cancer often doesn’t form distinct tumors — it tends to spread across the pleural lining. Radiation works best in early-stage cases with no metastasis or as a follow-up to surgery.
- The three main uses of radiation in mesothelioma treatment are: as a primary treatment for early-stage localized cancer, as adjuvant therapy (administered directly after surgery to kill remaining cancer cells), and for palliative care (reducing pain and pressure from large tumors).
- Intensity-Modulated Radiation Therapy (IMRT) is a newer, more precise form of radiation that uses 3-D visualization to conform the dose to the exact shape and size of the tumor — significantly reducing damage to surrounding healthy tissue and improving median survival rates when used as adjuvant therapy.
- External Beam Radiation Therapy (EBRT) is the traditional, less-targeted form of radiation — most commonly used in palliative care to relieve pain and pressure rather than as a curative treatment.
- Previous studies questioned whether radiation’s harm outweighed its benefits. Newer methods like IMRT are addressing those concerns by being more targeted, higher-dose, and lower-risk.
How Does Radiation Therapy for Mesothelioma Work?
Radiation is only one treatment option for mesothelioma. It utilizes high-energy forms of X-rays
or other charged particles in order to kill cancerous cells. This is different from chemotherapy
because the radiation is fixed to only attack cancerous cells; chemo is a systemic treatment,
meaning that both healthy and cancerous cells are affected. Although radiotherapy is more
specialized than other treatments (in terms of its impact), mesothelioma doesn’t typically
manifest in distinct tumors, which makes radiotherapy difficult. If a patient presents with an
early case of mesothelioma with no metastasis (spread), then radiotherapy might be a viable
option.
Another scenario in which radiation is used is called “adjuvant therapy.” Directly after surgery,
doctors administer radiation to the area in order to kill any small pockets of cancer that weren’t
removed in surgery.
Lastly, traditional radiotherapy is used in palliative care. This reduces discomfort for patients by
alleviating the pressure and pain caused by large tumors, but isn’t meant to be a long-term
treatment plan. Palliative care is likely the most common outlet of radiotherapy, as it has been
established that excess radiation exposure also has carcinogenic effects. So, if radiotherapy is
only used at end-of-life to reduce discomfort, then its carcinogenic effects are mitigated.
Intensity-Modulated Radiation Therapy (IMRT)
IMRT is a relatively new edition of radiotherapy, and it’s characterized as conformal. This means
that IMRT uses a 3-D visualization of the tumor in order to target the breadth and spread of the
tumor. The radiation is given in a high-dose, but it is extremely specialized: the dose size and
spread, again, is contingent on the tumor itself. This negates previous concerns about the
effectiveness of radiotherapy, as the treatment is tailored to each patient’s needs. Because IMRT
is also administered as conformal, the likelihood of it affecting other healthy tissues is very low.
A review study detailing the advancements in radiotherapy over the past 15 years noticed a trend
in IMRT: the median survival rate with IMRT used as adjuvant therapy increased patient survival
rate significantly. This is still a new form of radiotherapy, though, and clinical trials are still
working to affirm its benefits.
External Beam Radiation Therapy (EBRT)
EBRT is the traditional form of radiotherapy used to kill cancerous cells. It is the less-specific
version of IMRT–it’s not conformal, meaning its administration isn’t 3-D and its dose doesn’t
account for the size of the tumor. EBRT is used most commonly in palliative care to reduce sites
of pain and pressure from mesothelioma tumors, which is the common imagination of
radiotherapy. Ideally, as supplemented by information from clinical trials, IMRT will
overshadow EBRT as the dominant form of radiotherapy. Its specificity, high dosage, and
relatively lower risk makes it a treatment option comparable to chemotherapy or surgery.
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Frequently Asked Questions
How does radiation therapy work for mesothelioma?
Radiation therapy uses high-energy X-rays or charged particles directed at cancerous tissue to damage the DNA of cancer cells and stop them from dividing. Unlike chemotherapy — which is systemic and affects both healthy and cancerous cells throughout the body — radiation is localized, targeting only the area where the cancer is present. However, because mesothelioma often spreads across the pleural lining rather than forming a distinct tumor, targeting it with radiation can be challenging.
When is radiation therapy used to treat mesothelioma?
Radiation is used in three main settings:
- Primary treatment — for early-stage mesothelioma that has not spread (no metastasis), radiation may be used as a direct treatment to kill cancer cells
- Adjuvant therapy — administered immediately after surgery to eliminate small pockets of cancer that weren’t removed during the procedure
- Palliative care — used to reduce pain, pressure, and discomfort caused by large tumors in patients with advanced disease. This is the most common use of radiation for mesothelioma.
What is Intensity-Modulated Radiation Therapy (IMRT)?
IMRT is a newer, more precise form of radiation therapy that uses 3-D imaging to map the exact size, shape, and location of a tumor, then delivers a high-dose radiation beam that conforms to that specific shape. This “conformal” approach means the radiation is tailored to each patient’s tumor — maximizing the dose to the cancer while minimizing damage to surrounding healthy tissue. A review study of advancements in radiotherapy found that IMRT used as adjuvant therapy (after surgery) significantly increased median survival rates. Clinical trials continue to refine and validate this approach.
What is the difference between IMRT and EBRT?
The key differences are precision and application:
- IMRT (Intensity-Modulated Radiation Therapy) — uses 3-D visualization to conform the radiation dose to the exact shape and spread of the tumor. High-dose, highly targeted, and lower risk to surrounding tissue. Used for both curative and adjuvant treatment.
- EBRT (External Beam Radiation Therapy) — the traditional form of radiation. Less targeted — it doesn’t account for the 3-D shape of the tumor and is not conformal. Most commonly used in palliative care to relieve pain and pressure from tumors rather than as a curative treatment.
As IMRT technology continues to advance, it is expected to increasingly replace EBRT as the standard radiation approach for mesothelioma.
Is radiation therapy safe for mesothelioma patients?
Previous studies raised concerns about whether the side effects of radiation — including its own carcinogenic potential from excess exposure — outweighed its therapeutic benefits for mesothelioma. This is partly why palliative use (at end-of-life) has been the most common application, since long-term carcinogenic effects become less relevant. However, newer technologies like IMRT are addressing these concerns by delivering more precisely targeted, higher-dose radiation that reduces exposure to surrounding healthy tissue, making radiation a more viable treatment option at earlier stages.
Can radiation therapy cure mesothelioma?
Radiation therapy alone is generally not considered curative for mesothelioma because the cancer tends to spread across tissue linings rather than forming a single, distinct tumor that can be fully targeted. However, when used as adjuvant therapy after surgery — particularly with newer techniques like IMRT — radiation can significantly extend survival by eliminating remaining cancer cells. The most effective treatment plans typically combine surgery, chemotherapy, and radiation in a multimodal approach.
What should I do if I’ve been diagnosed with mesothelioma and want to understand my radiation therapy options?
If you or a loved one has been diagnosed with mesothelioma, understanding the full range of treatment options — including newer radiation techniques like IMRT — is an important step. Your oncologist can help determine whether radiation therapy, surgery, chemotherapy, or a combination is most appropriate for your specific situation. For information about your legal options, call (800) 505-6000 or fill out our contact form for a free consultation.
