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Transl Lung Cancer Res. 2018 Apr;7(2):189-198. doi: 10.21037/tlcr.2018.04.07.

Proton beam therapy for malignant pleural mesothelioma.

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University of Maryland School of Medicine, Baltimore, MD, USA.


Malignant pleural mesothelioma (MPM) is a rare disease with a poor prognosis. Surgical techniques have made incremental improvements over the last few decades while new systemic therapies, including immunotherapies, show promise as potentially effective novel therapies. Radiation therapy has historically been used only in the palliative setting or as adjuvant therapy after extrapleural pneumonectomy, but recent advances in treatment planning and delivery techniques utilizing intensity-modulated radiation therapy and more recently pencil-beam scanning (PBS) proton therapy, have enabled the delivery of radiation therapy as neoadjuvant or adjuvant therapy after an extended pleurectomy and decortication or as definitive therapy for patients with recurrent or unresectable disease. In particular, PBS proton therapy has the potential to deliver high doses of irradiation to the entire effected pleura while significantly reducing doses to nearby organs at risk. This article describes the evolution of radiation therapy for MPM and details how whole-pleural PBS proton therapy is delivered to patients at the Maryland Proton Treatment Center.


Malignant pleural mesothelioma (MPM); pencil-beam scanning (PBS); proton beam therapy; radiation; spot scanning

Conflict of interest statement

Conflicts of Interest: Dr. SN Badiyan and Dr. CB Simone 2nd have received speaker’s honoraria from Varian Medical Systems. The other authors have no conflicts of interest to declare.

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