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Radiation Therapy in Mesothelioma

  • Jonas Willmann
  • Andreas RimnerEmail author
Living reference work entry

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumor, arising from cells of the parietal or visceral pleura, that is linked to exposure to asbestos. The prognosis for MPM patients is extremely poor. In MPM patients, early symptoms are few and unspecific, so presentation with extensive disease is common. Therefore, many patients can only be treated in a palliative intent. For those who present at an early, potentially resectable tumor stage, multimodality treatment has been employed to control the disease. However, due to the limited number of clinical trials, many of the therapeutic approaches to date lack strong evidence and are subject to controversies and changes. The best evidence available is for the use of platinum/pemetrexed-based chemotherapy, with most recent data showing a small additional survival advantage of adding bevacizumab. There has been an ongoing debate as to how radical surgery in MPM should be used and to what degree it can prolong survival without causing additional morbidity. Radiation therapy (RT) has been a third important element in most multimodality regimens to control the disease locally. The complex anatomy of the pleura and its proximity to vital organs at risk, especially the lung, pose distinct challenges to radiation oncologists. Novel techniques such as intensity-modulated radiation therapy (IMRT), volume modulated arc therapy (VMAT), or proton therapy are promising options to precisely deliver effective doses of radiation with minimized toxicities. The combination of these state of the art techniques with systemic therapies or immune checkpoint inhibitors is currently under investigation and might potentially yield more promising outcomes for future patients.

Keywords

Malignant pleural mesothelioma Multimodality treatment Radical surgery Systemic therapy Radiation therapy 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Radiation OncologyMemorial Sloan-Kettering Cancer Center New YorkNew YorkUSA

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