NCCN Guidelines for Patients
Malignant Pleural Mesothelioma, Version 1.2014
Stage I–III epithelioid or mixed mesothelioma
After EPP, radiation therapy is recommended
as adjuvant treatment.
with radiation is recommended if you didn’t receive
chemotherapy before EPP surgery. Sequential
treatment is when one treatment is given after
another rather than both treatments given at the
same time. Radiation therapy uses high-energy rays
to treat cancer. The rays damage a cell’s instructions
for making and controlling cells. This either kills the
cancer cells or stops new cancer cells from being
made. Radiation can also harm normal cells and
cause side effects. Ask your treatment team for a list
of all the side effects of radiation therapy.
Radiation will be given to the side of your chest where
the tumor was and other areas decided by your
radiation oncologist. For mesothelioma, radiation is
often given using a machine outside the body. This
method is called EBRT (
Before beginning radiation therapy, pictures of your
chest will be taken with a CT scan using contrast.
This process is called simulation. Your radiation
oncologist will use the pictures to decide the radiation
dose and to shape the radiation beams. Beams are
shaped with computer software and hardware added
to the radiation machine. PET scans may also be
used for radiation treatment planning (simulation).
Your treatment team will decide the best time to
have radiation therapy after surgery. During radiation
treatment, you will lie on a table in the same position
as done during simulation. Devices may be used to
keep you from moving so that the radiation targets the
tumor. Likewise, methods may be applied to control
You will be alone while the technician operates the
radiation machine from a nearby room. He or she will
be able to see, hear, and speak with you at all times.
As treatment is given, you may hear noises.
One treatment session can take between 30 to 60
minutes. You will likely have 5 sessions a week.
Radiation therapy lasts 4 to 5 weeks if no cancer
cells are found in the normal-looking tissue around
the tumor removed during surgery. If cancer is found
in the normal-looking tissue, radiation therapy lasts
about 5 to 6 weeks.
The main types of EBRT used for mesothelioma
• 3D-CRT (three-
herapy) – Radiation is given in small
doses for a few weeks with x-ray beams that
match the shape of the tumor,
• IMRT (
– Radiation is given in small doses for a few
weeks with x-ray beams of different strengths
based on the thickness of the tumor,
• Tomotherapy – A type of IMRT, a tomotherapy
machine takes CT scans and delivers
• Proton beam therapy – Radiation is given
using proton beams, which deliver more
radiation at the end rather than throughout the
Conformal radiation therapy is the preferred method
by NCCN doctors. IMRT, tomotherapy, and proton
beam therapy are newer radiation therapy methods.
They should only be used in experienced cancer
centers or according to a specific, detailed treatment
plan called a protocol.