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Surgery remains the main therapeutic standard in the treatment of <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> with the goal of complete gross cytoreduction of the tumor. Because <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> is a diffuse disease affecting the entire mesothelial lining of the hemithorax, surgery alone can rarely achieve adequate tumor\u2010free resection margins. The surgical choices are pleurectomy\/decortication (<jats:styled-content style=\"fixed-case\">P\/D<\/jats:styled-content>) or extrapleural pneumonectomy (<jats:styled-content style=\"fixed-case\">EPP<\/jats:styled-content>). Radiotherapy (<jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>) is usually applied postoperatively with the aim to improve local control. However, the efficacy of <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content> is limited by the large volume of the target to be irradiated (tumor and pleural cavity) and the radiosensitivity of the nearby organs (heart, liver, lung, spinal cord, and esophagus). These factors have historically limited the effective radiation doses that can be given to the patient. There is no role for radical <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content> alone, but the role of <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content> as part of multimodality therapy is discussed. After <jats:styled-content style=\"fixed-case\">EPP<\/jats:styled-content> adjuvant <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content> to the entire hemithorax can reduce the recurrence rate and is well tolerated if strict limits to the dose to contralateral lung are applied: the <jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>20 and <jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>5 (the percent volume of the lung receiving more than 20<jats:styled-content style=\"fixed-case\">Gy<\/jats:styled-content> and 5<jats:styled-content style=\"fixed-case\">Gy<\/jats:styled-content> of radiation) correlate with increased lung toxicity. The use of modern sophisticated techniques allows good target coverage, more conformal high dose delivery, and clinically relevant normal tissue sparing.<\/jats:p>","DOI":"10.1111\/1759-7714.12008","type":"journal-article","created":{"date-parts":[[2012,11,1]],"date-time":"2012-11-01T14:19:10Z","timestamp":1351779550000},"page":"219-228","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of new radiation techniques in the treatment of pleural mesothelioma"],"prefix":"10.1111","volume":"4","author":[{"given":"Maurizio","family":"Amichetti","sequence":"first","affiliation":[{"name":"ATreP \u2013 Provincial Agency for Proton Therapy and Proton Therapy Unit S. Chiara Hospital  Trento Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Lorentini","sequence":"additional","affiliation":[{"name":"ATreP \u2013 Provincial Agency for Proton Therapy and Proton Therapy Unit S. 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