Whilst hemithorax irradiation may provide symptomatic benefit, no studies have shown that it prolongs survival [61] . Mesothelioma can involve large areas of the pleural cavity and use of radical radiotherapy over large fields places a range of organs such as lungs, liver, spinal cord or heart at a significant risk of dose related damage. As a result, a recent Cochrane review found no randomised clinical trial evidence to support the use of radical radiotherapy alone (or in combination with other treatment modalities) in mesothelioma [62] , and this treatment option has been shown to confer a significant mortality, with rates as high as 17% in one series [59] .