M.D. William W. Chance, C.M.D. Neal Rebueno, M.D. Daniel R. Gomez
This chapter describes current approaches in the use of intensity-modulated radiation therapy (IMRT) for mesothelioma (also known as malignant pleural mesothelioma). The standard of care for localized mesothelioma involves multimodality therapy. Whether the surgery should be extrapleural pneumonectomy or a lung-sparing approach such as pleurectomy/decortication has not been established, as the former has been linked with higher morbidity with no difference in local control. The technologic advances that have enabled the development and implementation of IMRT (4D CT-based treatment planning, dose-volume histogram analysis, inverse planning, and fluence modification) have enabled a high level of conformality to maintain the target dose while minimizing irradiation of surrounding normal tissues, which can potentially lead to reduced toxicity compared with conventional 2D radiation techniques. To date, some studies suggest that IMRT for mesothelioma has led to modest improvements in outcomes and particularly toxicity, but both local and distant recurrences remain common and thus long-term survival is rare.