Prophylactic Tract Irradiation

Prophylactic tract irradiation is a short course of radiation given to the skin and chest wall where a needle, drain or thoracoscopy port entered, to try to prevent mesothelioma from growing along that path. Two large British trials found it did not significantly reduce such growth, so it is no longer routinely recommended.

Origin

Mesothelioma's tendency to grow at procedure sites led doctors to try preventive radiation, and a small French trial in the 1990s suggested a benefit. Later randomized trials in the United Kingdom, SMART (published in 2016) and PIT (published in 2019), found no significant reduction in tract metastasis.

Significance in Asbestos Context

Tract metastasis, a painful lump at an old procedure site, worries patients and doctors. SMART and PIT compared radiation given soon after the procedure with waiting and treating only if a nodule appeared; neither found that preventive radiation significantly lowered the rate of tract metastases. British Thoracic Society guidance and other expert groups now advise against routine preventive radiation, while radiation remains useful to treat a painful nodule if one develops. Some centers may still consider it in individual cases. For families, this explains why one hospital may offer it and another may not, and why the absence of preventive radiation in a record is not, by itself, a sign of poor care. Records of every biopsy, drain and thoracoscopy, with dates and sites, help doctors watch the right places.

Example Sentence

After her thoracoscopy, her oncologist explained that preventive radiation to the port site was no longer routine and asked her to report any lump that appeared there.

Related Terms

Tract Metastasis, Thoracoscopy, Indwelling Pleural Catheter, Needle Biopsy, Clinical Trial, Intensity-Modulated Radiation Therapy (IMRT), Video-Assisted Thoracoscopic Surgery (VATS)

Notes

• Keep a list of every procedure site on your chest, with dates.
• Check old biopsy, drain and port sites from time to time, and report any new lump or pain.
• If a center offers preventive radiation, ask why it is recommended in your case.