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Radiation (radiotherapy, radiation therapy) is the type of mesothelioma treatment.
Because of the location of malignant mesothelioma, it is extremely difficult to deliver high enough doses of radiation to kill the tumor without damaging the surrounding organs. Lower doses of radiation can help to shrink the tumor, but it is unclear whether this helps people to survive longer than if they were not treated.
Using radiation therapy after surgery has not been shown to improve survival. However, because surgery is very unlikely to remove the entire tumor, radiation commonly is done after surgery in the hopes of killing remaining tumor cells. In addition, radiation therapy can be used to relieve the symptoms of mesothelioma, including chest pain.
Radiation therapy (or “radiotherapy”) involves the localized use of high–dose radiation such as x–rays on cancer tumors. The treatment works by destroying the cancer cells in the targeted area. Although normal cells may also be affected, they can repair themselves more effectively.
Radiation therapy can both reduce the size of a tumor and relieve symptoms like pain and shortness of breath. However, your doctor may limit its use depending on the volume of the tumor and how close it is to other vital organs.
Your doctor may prescribe radiation therapy alone, with chemotherapy, or after surgery to reduce the chances of mesothelioma recurring.
Radiation therapy may be delivered externally or internally. External radiation delivers high-energy rays directly to the cancer from a machine outside the body. Internal radiation, or brachytherapy, is the implantation of a small amount of radioactive material (seeds) in or near the cancer. Radiation can also be delivered as an isotope into a vein, as in the use of radioactive iodine for the treatment of thyroid cancer.
External Beam Radiation Therapy (EBRT)
EBRT is given via machines called linear accelerators, which produce high-energy external radiation beams that penetrate the tissues and deliver the radiation dose deep in the areas where the cancer resides. These modern machines and other state-of-the-art techniques have enabled radiation oncologists to significantly reduce side effects while improving the ability to deliver radiation.
EBRT is typically delivered on an outpatient basis for approximately 6 to 8 weeks. EBRT begins with a planning session, or simulation, during which the radiation oncologist places marks on the body and takes measurements in order to line up the radiation beam in the correct position for each treatment. During treatment, the patient lies on a table and is treated with radiation from multiple directions. The actual area receiving radiation treatment may be large or small, depending on the features of the cancer. Radiation can be delivered specifically to an organ or encompass the surrounding area, including the lymph nodes.
Three-dimensional conformal radiation therapy (3D-CRT)
EBRT can be delivered more precisely by using a special computed tomography (CT) scan and a targeting computer. This capability is known as three-dimensional conformal radiation therapy, or 3D-CRT. The use of 3D-CRT appears to reduce the chance of injury to nearby body structures. Since 3D-CRT can better target the area of cancer, radiation oncologists are evaluating whether higher doses of radiation can be given safely and with greater cancer cures.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is an advanced form of 3-D conformal radiation therapy. IMRT, also called tomotherapy, delivers varying intensity of radiation with a rotating device. The rotating component of this technique allows for more specific targeting of the cancer. In conventional radiation therapy, the beam is usually delivered from several different directions, possibly 5-10. The greater the number of beam directions, the more the dose will be confined to the target cancer cells, sparing normal cells from exposure. IMRT delivers radiation from every point on a helix, or spiral, in contrast to only a few points.
IMRT is similar to computed tomography (CT) scanning. In CT, a beam rotates around the patient, creating a sequence of cross-sectional images. IMRT also uses a rotating beam, except the beam delivers radiation. IMRT also delivers treatment one cross-section at a time.
Internal radiation is known by a number of names: "interstitial brachytherapy," "seeds," or "implantation." These terms refer to treatment in which radioactive material is placed directly into or near the cancer. For example, a common method for the treatment of prostate cancer is interstitial brachytherapy. This consists of permanent implantation of radioactive seeds into the prostate gland through the perineum.
After the procedure, the patient will temporarily contain a small amount of radiation from the seeds, although this amount is not generally dangerous to most other people. Some physicians may advise patients to avoid close contact with young children or pregnant women for several weeks. Because implant radiation focuses the radiation closely around the cancer, this form of radiation typically works best in patients with early stage cancers.
Breast brachytherapy is an alternative to traditional EBRT for women who choose breast conservation rather than a mastectomy. Breast conservation therapy involves removing the tumor in a procedure called a lumpectomy, and is followed by radiation therapy to reduce the likelihood of recurrence. Traditional EBRT following a lumpectomy consists of five to six weeks of radiation treatment, five days per week.
With breast brachytherapy, a site-specific, prescribed dose of radiation is administered during a five-day course of therapy. Because of the relatively short duration of the treatment course, breast brachytherapy is an attractive option for women who choose lumpectomy over mastectomy, but do not wish to undergo 6 weeks of EBRT.
The procedure for breast brachytherapy involves inserting a deflated balloon into the cavity where the tumor was removed. An applicator shaft, or catheter, connects the balloon to the outside of the breast. The balloon is filled with saline, and both the balloon and the catheter remain in place during the time the woman is undergoing treatment.
Stereotactic Radiosurgery (SRS)
Stereotactic Radiosurgery (SRS) allows non-invasive treatment of brain tumors, arteriovenous malformation, and other selected conditions.A It is an outpatient treatment that delivers a high dose of radiation to a highly defined target.A Treatments can be prescribed to deliver the total dose of radiation in a single treatment or in a fractionated manner over a course of several weeks.
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