Skip to main content
  • 289 Accesses

Abstract

Radiation therapy (RT) is an important treatment option for malignant pleural mesothelioma (MPM). It can be employed as part of a definitive multimodality treatment approach in conjunction with chemotherapy and surgery in an attempt to control the disease locally. The complex anatomy of the pleura and its proximity to vital organs at risk, such as the lungs, heart, esophagus, and brachial plexus, pose distinct challenges. Novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), or proton therapy are able to precisely deliver effective RT doses while minimizing toxicities. Prospective studies have demonstrated the technical feasibility and safety of IMRT pre- or post-surgery with encouraging clinical outcomes. Ongoing studies are expanding the expertise of these complex RT techniques to more mesothelioma centers as the basis for performing high-quality multicenter prospective clinical trials that may determine the true efficacy of the addition of RT to surgical and systemic therapies. RT also plays an important role in the palliation of MPM-related pain, obstructive symptoms, and vascular invasion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Allen AM, Czerminska M, Jänne PA, Sugarbaker DJ, Bueno R, Harris JR, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys. 2006;65(3):640–5.

    Article  Google Scholar 

  • Chance WW, Rice DC, Allen PK, Tsao AS, Fontanilla HP, Liao Z, et al. Hemithoracic intensity modulated radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma: toxicity, patterns of failure, and a matched survival analysis. Int J Radiat Oncol Biol Phys. 2015;91(1):149–56. PubMed PMID: 25442335. Epub 2014/12/03. Eng.

    Article  Google Scholar 

  • Clive AO, Taylor H, Dobson L, Wilson P, de Winton E, Panakis N, et al. Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial. Lancet Oncol. 2016;17(8):1094–104.

    Article  Google Scholar 

  • de Perrot M, Feld R, Leighl NB, Hope A, Waddell TK, Keshavjee S, et al. Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2015. PubMed PMID: 26614413. Epub 2015/11/29. Eng.

    Google Scholar 

  • Dumane V, Rimner A, Yorke ED, Rosenzweig KE. Volumetric-modulated arc therapy for malignant pleural mesothelioma after pleurectomy/decortication. Appl Radiat Oncol. 2016;5(4):24–33.

    Google Scholar 

  • Flores RM, Pass HI, Seshan VE, Dycoco J, Zakowski M, Carbone M, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg. 2008;135(3):620–6.e3.

    Article  Google Scholar 

  • Fodor A, Fiorino C, Dell’Oca I, Broggi S, Pasetti M, Cattaneo GM, et al. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma. Strahlenther Onkol. 2011;187(11):736–43.

    Article  Google Scholar 

  • Gupta V, Mychalczak B, Krug L, Flores R, Bains M, Rusch VW, et al. Hemithoracic radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2005;63(4):1045–52.

    Article  Google Scholar 

  • Krayenbuehl J, Oertel S, Davis JB, Ciernik IF. Combined photon and electron three-dimensional conformal versus intensity-modulated radiotherapy with integrated boost for adjuvant treatment of malignant pleural mesothelioma after pleuropneumonectomy. Int J Radiat Oncol Biol Phys. 2007;69(5):1593–9.

    Article  Google Scholar 

  • Krayenbuehl J, Hartmann M, Lomax AJ, Kloeck S, Hug EB, Ciernik IF. Proton therapy for malignant pleural mesothelioma after extrapleural pleuropneumonectomy. Int J Radiat Oncol Biol Phys. 2010;78(2):628–34. PubMed PMID: 20385451. Epub 2010/04/14. Eng.

    Article  Google Scholar 

  • Kristensen CA, Nøttrup TJ, Berthelsen AK, Kjær-Kristoffersen F, Ravn J, Sørensen JB, et al. Pulmonary toxicity following IMRT after extrapleural pneumonectomy for malignant pleural mesothelioma. Radiother Oncol. 2009;92(1):96–9.

    Article  Google Scholar 

  • Krug LM, Pass HI, Rusch VW, Kindler HL, Sugarbaker DJ, Rosenzweig KE, et al. Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol. 2009;27(18):3007–13.

    Article  CAS  Google Scholar 

  • MacLeod N, Chalmers A, O’Rourke N, Moore K, Sheridan J, McMahon L, et al. Is radiotherapy useful for treating pain in mesothelioma?: a phase II trial. J Thorac Oncol. 2015;10(6):944–50. PubMed PMID: 25654216. Epub 2015/02/06. Eng.

    Article  Google Scholar 

  • Minatel E, Trovo M, Polesel J, Baresic T, Bearz A, Franchin G, et al. Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up. Lung Cancer. 2014;83(1):78–82. PubMed PMID: 24216141. Epub 2013/11/13. Eng.

    Article  Google Scholar 

  • Pan HY, Jiang S, Sutton J, Liao Z, Chance WW, Frank SJ, et al. Early experience with intensity modulated proton therapy for lung-intact mesothelioma: a case series. Pract Radiat Oncol. 2015;5(4):e345–53. PubMed PMID: 25572666. Epub 2015/01/13. Eng.

    Article  Google Scholar 

  • Patel PR, Yoo S, Broadwater G, Marks LB, Miles EF, D’Amico TA, et al. Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2012;83(1):362–8.

    Article  Google Scholar 

  • Pehlivan B, Topkan E, Onal C, Nursal GN, Yuksel O, Dolek Y, et al. Comparison of CT and integrated PET-CT based radiation therapy planning in patients with malignant pleural mesothelioma. Radiat Oncol. 2009;4:35.

    Article  Google Scholar 

  • Rice DC, Smythe WR, Liao Z, Guerrero T, Chang JY, McAleer MF, et al. Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2007a;69(2):350–7.

    Article  Google Scholar 

  • Rice DC, Stevens CW, Correa AM, Vaporciyan AA, Tsao A, Forster KM, et al. Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2007b;84(5):1685–93.

    Article  Google Scholar 

  • Rice D, Rusch V, Pass H, Asamura H, Nakano T, Edwards J, et al. Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: A consensus report of the International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group. J Thorac Oncol. 2011;6(8):1304–12.

    Article  Google Scholar 

  • Rimner A, Spratt DE, Zauderer MG, Rosenzweig KE, Wu AJ, Foster A, et al. Failure patterns after hemithoracic pleural intensity modulated radiation therapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2014;90(2):394–401. PubMed PMID: 25073664. Epub 2014/07/31. Eng.

    Article  Google Scholar 

  • Rimner A, Simone 2nd CB, Zauderer MG, Cengel KA, Rusch VW. Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? Lancet Oncol. 2016a; in press.

    Google Scholar 

  • Rimner A, Zauderer MG, Gomez DR, Adusumilli PS, Parhar PK, Wu AJ, et al. Phase II study of hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) as part of lung-sparing multimodality therapy in patients with malignant pleural mesothelioma. J Clin Oncol. 2016b;34(23):2761–8. PubMed PMID: 27325859. Pubmed Central PMCID: PMC5019761. Epub 2016/06/22. Eng.

    Article  CAS  Google Scholar 

  • Rosenzweig KE, Zauderer MG, Laser B, Krug LM, Yorke E, Sima CS, et al. Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2012;83(4):1278–83.

    Article  Google Scholar 

  • Rusch VW, Rosenzweig K, Venkatraman E, Leon L, Raben A, Harrison L, et al. A phase II trial of surgical resection and adjuvant high dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2001;122(4):788–95.

    Article  CAS  Google Scholar 

  • Shaikh F, Zauderer MG, von Reibnitz D, Wu AJ, Yorke ED, Foster A, et al. Improved outcomes with modern lung-sparing trimodality therapy in patients with malignant pleural mesothelioma. J Thorac Oncol. 2017. PubMed PMID: 28341225. Epub 2017/03/28. Eng.

    Google Scholar 

  • Stahel RA, Riesterer O, Xyrafas A, Opitz I, Beyeler M, Ochsenbein A, et al. Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol. 2015. PubMed PMID: 26538423. Epub 2015/11/06. Eng.

    Google Scholar 

  • Taioli E, Wolf AS, Flores RM. Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma. Ann Thorac Surg. 2015;99(2):472–80. PubMed PMID: 25534527. Epub 2014/12/24. Eng.

    Article  Google Scholar 

  • Treasure T, Lang-Lazdunski L, Waller D, Bliss JM, Tan C, Entwisle J, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol. 2011;12(8):763–72.

    Article  Google Scholar 

  • Yajnik S, Rosenzweig KE, Mychalczak B, Krug L, Flores R, Hong L, et al. Hemithoracic radiation after extrapleural pneumonectomy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2003;56(5):1319–26.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andreas Rimner .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rimner, A. (2019). Radiation Therapy. In: Hesdorffer, M., Bates-Pappas, G. (eds) Caring for Patients with Mesothelioma: Principles and Guidelines. Springer, Cham. https://doi.org/10.1007/978-3-319-96244-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96244-3_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96243-6

  • Online ISBN: 978-3-319-96244-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics