Impact of Radiation Therapy on Malignant Mesothelioma: Are We Ready for Use in Clinical Practice, Combined with Surgery or Alone?

Abstract

Technology for providing radiation therapy (RT) has advanced significantly over the last decade, allowing for more accurate delivery and safer radiation doses. However, malignant mesothelioma (MPM) can rapidly expand in the chest, and full hemithoracic radiation can cause serious lung complications. Traditionally, the main roles of RT included prophylactic irradiation of intervention tracts (PIT), adjuvant therapy after radical surgery (as multimodality therapy), and symptomatic treatment. Of these options, recent findings indicate that PIT is not recommended for routine use. The role of RT as an adjuvant therapy is also changing with changes in surgical methods. Although RT after extrapleural pneumonectomy has shown some effect as a part of tri-modal therapy, the role of RT after lung-sparing surgery is still uncertain. Recently, intensity-modulated pleural RT has been shown to be promising in several studies, but currently, this therapy is only recommended if provided by a team of highly trained experts and when subject to strict dose constraints and aggressive toxicity management. The role of RT as symptomatic treatment is still important. Because MPM has a high infiltrating tendency, symptoms progress at a very fast rate. However, better quality of life may be maintained by using RT, if properly timed with systemic treatment.

MPM is an aggressive tumor with a poor prognosis, but the number of cases per institution is small. It is essential to continue to build a consensus regarding treatment across facilities worldwide.