Key takeaways: Radiotherapy utilizes highly programmable and specialized radiation beams to kill mesothelioma cells. Most commonly, it’s used after surgery and as a facet of palliative care to reduce discomfort. Usually, radiotherapy isn’t a first-line tactic, although it’s becoming more advanced and specific. A recent review study proposed a working guideline to implementing radiotherapy as both an adjuvant and palliative therapy. In the review, the researchers detail the specifics for assessing the utility of radiotherapy in different clinical scenarios.
How does radiotherapy work?
Radiotherapy works by employing high-frequency radiation beams to kill mesothelioma cells. These beams of radiation are usually X-rays, and they can be modified to target the exact topographies of tumors. Advancements in the scoring and administration of radiation have made it a more specialized and reliable technique, especially in more recent years. Image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT) have revolutionized the applicability of radiotherapy. IGRT uses imaging technology to visualize and guide radiation, while IMRT uses different scales of radiation intensity to target tumors. IMRT and IGRT are the most commonly used forms of radiation for treatment.
Usually, radiotherapy is used as a prong of palliative care approaches, but is sometimes used as an “adjuvant” technique. An adjuvant technique refers to a therapeutic approach that is meant to supplement another technique. In this case, radiotherapy would act as an adjuvant to chemotherapy or surgery. Regardless of its use, radiotherapy is almost always used in conjunction with another mode of treatment, even though it’s gotten better at targeting and killing mesothelioma tumors.
When is radiotherapy used?
In most cases, clinicians do not opt for radiotherapy as a first-line tactic. Radiotherapy is exceptional at targeting “leftover” mesothelioma cells, as doctors can use the exact dimensions of tumors in order to program the intensity, breadth, and frequency of waves used. If a surgery has a curative intent—meaning that it’s being performed in order to reduce or stabilize tumor conditions—radiation can be administered post-surgery. Because the doctors already scored the dimensions of the tumor, radiation can be used to “retrace” the contours of the surgery. Radiotherapy works to kill any mesothelioma cells that might’ve been left after surgery, as it only takes a few intact cells for a tumor to regrow.
As a palliative care tactic, radiotherapy can reduce pain via alleviating the pressure associated with tumors. (Palliative care isn’t hospice, as it seeks to reduce symptoms of pain—it isn’t only associated with end-of-life care. Most mesothelioma patients receive some form of palliative care.) Radiotherapy can be used to shrink tumors, or to alleviate shortness of breath/painful everyday movements. The side effects are minimal compared to other pharmacological palliative techniques; additionally, patients don’t need to receive multiple rounds of radiotherapy, like they would for chemotherapy or a set of pain-relieving drugs.
Is radiotherapy a reliable medium of treatment?
A recent review study (Gomez M.D., et al.) assessed the utility of radiotherapy in different applications/locales in mesothelioma treatment. They developed a standard of treatment, in which they proposed different scenarios for radiotherapy use and the corresponding type (and dose) of radiation that should be employed.
A standard of care—like described by Dr. Gomez et al.—could help to:
a.) make radiotherapy a more standard facet of care;
b.) destigmatize preconceived notions around radiation as therapy; and
c.) use context to assess the utility of radiotherapy for different patients.
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Sources:
https://radonc.ucsf.edu/conditions-treatments/types-of-treatment/image-guided-radiation-therapy/
https://www.jto.org/article/S1556-0864(19)30380-6/fulltext#secsectitle0110
https://www.cancer.org/cancer/types/malignant-mesothelioma/treating/radiation.html
