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Radiation Therapy for Mesothelioma
Radiation Therapy for Mesothelioma
In the effort to shrink tumors and/or prevent cancer recurrences, mesothelioma patients can receive radiation therapy before, after, or during surgery. On its own, radiation can alleviate pain as it typically carries fewer side-effects compared to chemotherapy. This treatment can be utilized during any stage of cancer.
How Does Radiation Therapy Treat Mesothelioma?
Preventing cancer cells from spreading to improve life expectancy is the main goal of radiation therapy. It is used by doctors either alone to manage symptoms as a palliative therapy or in combination with other treatments.
Oncologists have used radiation as a cancer treatment for decades, and advances in technology have made it an exceedingly refined treatment. With well-targeted radiation, cancer cells can be killed without triggering the serious side effects that typically accompany chemotherapy.
A study to review the outcomes for thousands of pleural mesothelioma patients was conducted by researchers at New York’s Icahn School of Medicine in 2016. Overall, the survival of patients who had received radiation therapy were nearly doubled at the two- and five-year marks – regardless of what additional treatments were used.
Throughout the different stages of mesothelioma, doctors can provide radiation therapy for numerous varying reasons.
Benefits of Radiation Therapy for Mesothelioma
Improved Survival – The risk of local recurrence is reduced when combing chemotherapy with surgery; which aids in potential life expectancy increasement. With this approach, some patients live three to five years longer.
Pain Relief – By reducing the size of mesothelioma tumors, as result of radiation therapy, pain is alleviated relieving pressure on both the chest and lungs. Positive symptom relief after the therapy was reported by approximately 60 percent of mesothelioma patients.
Seeding Prevention – When microscopic cancer cells can relocate to new areas during surgery, it is considered “seeding”. It is common for radiation therapy along incision sites. In fact, modest radiation at drain tube sites or surgery can be beneficial.
Types of Radiation for Mesothelioma
Radiation can be applied both internally and externally for malignant mesothelioma. The internal form is brachytherapy, whereas the external form is called external beam radiation therapy (EBRT). Pleural mesothelioma more commonly utilizes EBRT as it has proven to be more effective.
External Beam Radiation
Despite external beam radiation involving high-energy rays to target malignant tumors directly, it is noninvasive. The tumors general health of the patient, location, size, and staging of the cancer are all under consideration by experienced radiologist who perform such treatment
To guarantee healthy cells are not damaged, the computer guides the radiation machine in order to deliver precise doses to specific areas – in order to help reduce the risk of adverse reactions.
Multiple doses are emitted as the radiation beam conforms to the three-dimensional shape of the tumor. This permits doses of higher radiation within the tumor, while also minimizing the dose to the surrounding tissues and organs.
Intensity-modulated radiation therapy (IMRT), an advanced form of the 3-D conformal radiation therapy, is the most common and effective kind of EBRT for mesothelioma. The strength of the beam fluctuates in specific areas to accurately target tumors.
Sessions for external beam radiation are notably fast, as they only take a few minutes and are painless. However, set up time – preparing patients in the proper position for treatments – can add additional time. Treatments are generally arranged five days a week for several weeks.
A type of radiation therapy that has the ability to kill cancer cells by implantation of radioactive materials into a tumor is known as brachytherapy.
Doctors may either place the radioactive material during a procedure, or by means of a hollow tube with assistance of an imaging scan. To prevent cancer from spreading, the brachytherapy may also be applied to biopsy and surgical scars temporarily.
When placed into a tumor site, it has been efficient in treating lung cancer though is rarely used for mesothelioma treatment.
Timing Impacts Results
External beam radiation therapy can be applied by doctors at varying times to achieve different effects – however, as a single treatment, EBRT can be applied at any time to aid in pain control.
The EBRT can combined with surgery for pleural mesothelioma – whether applied before, during, or after the surgical procedure.
Radiation Therapy After Surgery
Multimodal therapy for pleural mesothelioma traditionally begins with chemotherapy, followed by surgery, and then radiation therapy; prior to the patient’s recovery from surgery.
Radiation is used in this setting to kill cancer cells left behind during the surgery. The risk of local recurrence is reduced and/or delayed by this technique.
With this treatment, about half of patients with early-stage epithelioid mesothelioma can live longer than five years.
Surgery for Mesothelioma After Radiation Therapy (SMART)
As a “reversal” of the traditional protocol, this approach to treatment has produced remarkable results for some patients battling mesothelioma.
Specialists from two leading cancer centers in Toronto estimated a median overall survival of 51 months in pleural mesothelioma patients using the SMART approach in a 2015 study. About 66 percent of early-staged patients with epithelioid tumors lived longer than three years.
To safely execute the SMART approach, an experienced multidisciplinary team is essential. Fatal results could emerge if the lung is not removed subsequently after high radiation levels have been applied. This means that a patient must follow through with surgery after he or she receives radiation.
Intraoperative Radiation Therapy
Intraoperative radiation therapy (IORT) is used as part of surgery.
The beams are applied to the affected areas by radiologist to help prevent seeding – or spreading of the cancer cells – during the operation. Immediately following tumor removal, a concentrated dose of radiation is dispersed to the site of the tumor.
This option may help some patients finish treatment sooner and therefore the need for additional radiation following surgery could be reduced. Patients who need additional radiation sessions can receive a boost from IORT and generally may experience fewer complications.
Radiation Therapy Process
Patients typically go through an initial consultation, get imaging scans, and receive treatment on an outpatient basis to become better informed as to what to expect during radiation therapy.
First Appointment: Meeting with a radiation oncologist will occur during the consultation visit in order to discuss the best approach for your case. You may be asked to sign a consent form after being fully informed of the process in order to proceed with the treatment.
Imaging Scans: To determine the exact shape, size, and location of the tumor(s), imaging scans are performed. The radiation application is based on these images in order to guarantee greater accuracy and safety.
Treatment: What must be done before, during, and after treatment will be explained by a medical professional. Assistance for positioning and applying protective coverings to prevent exposure of healthy tissues from radiation will also be provided. Generally, radiation is applied one or more times a week for several weeks.
Follow-Up Appointment: Your doctor will check for signs of side effects during follow-up appointments. Additional imaging scans will also be taken to observe the radiations effect on the tumor size
Types of Mesothelioma
Pleural mesothelioma arises in the membrane which surrounds the lung, called the pleura. Pleural mesothelioma is the most common form of this deadly cancer.
Peritoneal mesothelioma develops in the lining of the abdominal cavity, called the peritoneum. Peritoneal mesothelioma is less common but is more often found in women than in men.
Pericardial mesothelioma originates in the pericardium, which lines the heart.
Common Side Effects of Radiation Therapy
There is no need to worry about pain while undergoing treatments radiation therapy is not painful during administration.
Some patients may experience skin irritation around the location where radiation was delivered following treatment.
Radiation side effects are more often temporary and generally more constrained than those of chemotherapy, which could affect the whole body. However, some side effects of radiation may be chronic and occur months or years after treatment has been completed.
Most side effects develop because tissue damage builds up during several radiation sessions. A single cycle can last up to 8 weeks. As treatment progresses, the side effects are often more severe.
Common side effects of radiation include:
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Radiation Side Effects by Mesothelioma Type
Radiation exposure to healthy tissues can be reduced by delivering advanced methods of radiation therapy – though there may still be some side effects in the area in which radiation has entered the body.
The type of diagnosis of mesothelioma influences how an individual’s body reacts to radiation treatment.
Symptoms of pleural mesothelioma – such as difficulty swallowing, coughing, and shortness of breath, could become temporarily intensified while receiving radiation treatments to the chest.
Fibrosis, or scarring of the lungs, could occur in rare cases.
Radiation to the chest can result in inflammation of the lining of the heart or lungs. Damage to the heart muscle, resulting is cardiac toxicity, may also be at risk.
Additional rare complications include calcification of the lymph nodes, collapsed lungs, and fluid buildup (pleural effusions). Research shows that pleural effusions are typically reported within six months of the initial radiation treatment if they develop at all.
Due to location, radiation treatment has constrained handiness for those with peritoneal mesothelioma.
Peritoneal cancer involves the abdominal cavity lining. Radiation can be extremely toxic to the kidneys, liver, small intestines, and other organs in this area.
The only form of radiation used in peritoneal patients is to prevent surgical scars and biopsies from spreading cancer.
Patients who receive radiation to the abdomen generally face common side effects such as nausea and vomiting. These side effects can be initiated by radiation damage to the gastrointestinal tract and are common in patients undergoing additional mesothelioma treatments – especially chemotherapy.
Bladder inflammation, known as cystitis, can also occur. Experiencing difficulty to empty your bladder completely, urination at normal intervals, or the ability to control the flow of urine from your bladder when you sneeze/cough may arise.
Urine may seem bloody or the bladder may start to cramp or spasm in rare cases. Such side effects may occur within three to five weeks of treatment.
Is Radiation Therapy Right for You?
Despite recent advances, several experts question the merits of mesothelioma radiation therapy; these concerns stem from the incoherent results of scientific studies and clinical trials.
It is up to you and your oncologist when deciding to include radiation therapy in your treatment plan – the potential benefits may outweigh the side effects and risks.
A consultation with your oncologist to discuss both pros and cons regarding therapy should be set in order to make the best-informed decision.
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