Abstract
The pattern of spread of malignant pleural mesothelioma (MPM) poses unique challenges to a radiation oncologist. Since the disease is most often confined to the ipsilateral pleura, local control is the primary concern, particularly after surgical resection. Yet, treating the entire pleura requires a large radiation field, increasing toxicity risks. Initially, when administering radiotherapy (RT) as adjuvant therapy following extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), patients were treated with conventional radiation techniques using anterior and posterior fields. More recently, complex intensity-modulated radiation therapy (IMRT) techniques for the treatment of MPM have been explored, with early outcomes suggesting acceptable safety in appropriately selected patients. Here, we review the lessons learned from conventional radiation techniques and the development of novel radiation techniques for MPM treatment.
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