Inclusion Criteria:

• Histological/MDT diagnosis MPM

• Recent contrast-enhanced CT chest/abdomen (within 8 weeks of starting radiotherapy)

• Worst MPM-associated pain score ≥4/10 after analgesia optimisation

• Life expectance ≥ 12 weeks

• ECOG Performance Status 0-2

• Radiotherapy plan compatible with dose-escalated arm (36Gy in 6 fractions) prior to randomisation



 Exclusion Criteria:

• Anti-cancer therapy 4 weeks prior to study entry or 6 weeks after radiotherapy

• Psychotic disorders or cognitive impairment

• Co-existing lung tumours at the time of study entry

• Patients who have previously received palliative radiotherapy and where there is concern that the proposed treatment volume would overlap with a previously irradiated area. This does not include patients who have received superficial photon or electron therapy to drain sites

• Pregnant or breastfeeding patients

• Patients of child-bearing potential, unwilling to use 2 effective methods of contraception

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