SMART Protocol Shows “Encouraging Results” for Mesothelioma Patients


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On-going surgeryResearchers report that treating late-stage mesothelioma patients with a high dose of radiation prior to performing radical extrapleural pneumonectomy surgery results in “encouraging results” and should be further studied.

According to an article in the Journal of Thoracic Oncology, a study conducted by researchers from the Princess Margaret Cancer Center in Toronto with 25 patients with malignant pleural mesothelioma, who were deemed candidates for EPP, underwent SMART treatment [Surgery for Mesothelioma After Radiation Therapy.]  The patients had a three-year survival (72%) that was more than double the survival (32%) of patients who underwent other treatment protocols.

Mesothelioma, a terminal form of cancer caused by exposure to airborne asbestos fibers, often has a complex growth pattern making complete surgical removal a very difficult task. The goal of surgery is to achieve a macroscopically-complete resection, which refers to the removal of all visible tumor cells. There has been an ongoing debate among mesothelioma physicians as to the best surgical approach for improving the survival of mesothelioma patients.

Extrapleural pneumonectomy (EPP) is a radical and complex surgery that features the removal of the affected lung and parietal pleura, as well as the possible removal of the diaphragm, the pericardium and other extrapleural tissue. The alternative surgical option, pleurectomy/decortications (P/D) strips away the diseased membrane lining the lung and visible mesothelioma tumors, but spares the lung.

The research, led by Marc de Perrot, MD, Princess Margaret Cancer Center in Toronto, included giving the previously untreated mesothelioma patients five doses of Intensity-Modulated Radiation Therapy. IMRT enables the radiation oncologist to conform the radiation beams to tumors that are actually wrapped around other structures. Within one week of receiving IMRT, the patients underwent EPP.

According to an article in MedPage Today, de Perrot reports an additional 20 mesothelioma patients have undergone SMART treatment and their three-year overall survival is approaching 90%.

The researchers concluded that the results support “future studies looking at long-term outcome in patients with epithelial subtypes [of mesothelioma].”

Mesothelioma is diagnosed in approximately 3,000 Americans each year. The average survival time varies from 4 – 18 months after diagnosis.

MedPage Today

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