➤ Radiation therapy should be offered as an effective treatment modality
to palliate patients with symptomatic disease. (Strong Recommendation;
EB-I)
➤ It is recommended that standard dosing regimens used in other diseases
be offered to patients with mesothelioma (8 Gy x 1 fraction, 4 Gy x
5 fractions or 3 Gy x 10 fractions). (Strong Recommendation; EB-I)
➤ Radiation therapy may be offered to patients with localized asymptomatic
recurrence. The dosing fractionation is dependent on the site and extent
of disease and should be determined by the radiation oncologist in
consultation with the patient. (Moderate Recommendation; IC)
➤ Hemithoracic adjuvant radiation therapy may be offered to patients who
undergo non-lung sparing cytoreductive surgery (EPP), preferably in
centers of excellence with experience in this modality for mesothelioma.
(Strong Recommendation; EB-I)
➤ Hemithoracic neo-adjuvant radiation therapy may be offered to patients
who undergo non-lung sparing cytoreductive surgery. This potentially
toxic regimen remains experimental and should be performed only in
highly experienced centers within the context of a clinical trial. (Moderate
Recommendation; EB-I)
➤ Hemithoracic adjuvant intensity-modulated radiation therapy may be
offered to patients who undergo lung sparing cytoreductive surgery (P/D
or EPD). This potentially toxic regimen should be performed only in highly
experienced centers, preferably in the context of a clinical trial. (Moderate
Recommendation; EB-I)
➤ Due to the potential for severe pulmonary toxicity, neoadjuvant radiation
therapy is NOT recommended for patients who undergo lung sparing
surgical cytoreductive surgery. (Strong Recommendation; IC)
➤ For palliative radiation therapy, electrons, 2D, 3D, and IMRT may be
considered appropriate techniques depending on location of the treatment
target and organs at risk. (Strong Recommendation; EB-I)
➤ For adjuvant or neoadjuvant hemithoracic radiation therapy, 3D or IMRT
may be offered, respecting guidelines of organs at risk. Proton therapy
may be considered in centers with significant experience, preferably in
the context of a clinical trial. (Strong Recommendation; EB-I)
➤ It is recommended that standard dosimetric guidelines for organs at
risk be used as established predictors of radiation toxicity. (Strong
Recommendation; EB-I)
