Malignant Pleural Mesothelioma (MPM) is a rare malignancy with a dismal prognosis. Majority of patients present with advanced disease and has a high symptom burden. Patients often have uncontrolled pain due to tumour infiltration of the chest wall, despite multiple analgesics. Systemic chemotherapy (Cisplatin and Pemetrexed) provide a modest survival benefit in addition to symptom control and is a standard of care in these patients. Radiation therapy is often used to palliate pain in these patients but there is limited evidence and no consensus on optimal dose and fractionation. Recent technological advances in radiation therapy such as intensity modulated radiation therapy, allows delivery of high dose of radiation to a large volume in the hemithorax with less toxicity. Dose escalation may result in more effective palliation of symptoms. This presentation will focus on the role of palliative radiation therapy, dose and fractionation in patients with unresectable MPM.