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SMART Mesothelioma Procedure Could Extend the Lives of Certain Mesothelioma Patients

Published: January 29, 2021

Accelerated high dose radiation before surgery created a 65.9 month survival for mesothelioma patients. They were part of a clinical trial in Toronto at the Princess Margaret Cancer Center. The study is named SMART, an acronym for Surgery for Mesothelioma After Radiation Therapy. There were 96 patients who were treated between the years 2008 and 2019. The patients received intensity modulated chemotherapy before undergoing an extrapleural pneumonectomy, which is an extreme surgery that removes part of the lung, part of the diaphragm, and the linings of the heart and lungs. There were 19 patients with epithelioid mesothelioma and no spread to lymph nodes. These patients were able to exceed a five-year median survival after receiving a multimodal surgery for the first time.

Mesothelioma is a horrible cancer with most patients dying within a year of being diagnosed. Not many patients are able to receive surgery because the cancer has spread too much. When patients are able to undergo surgery, the median survival is only two years. Not many centers in North America that treat mesothelioma use SMART, but one of them is the Princess Margaret Cancer Center. Hospitals typically will treat patients with chemotherapy, then surgery, and then radiation. Using radiation first helps stimulate the immune system and helps to prevent cancer from moving to the chest cavity when a patient is undergoing surgery.

The study wanted to see if the SMART protocol for treating mesothelioma was feasible in a clinical setting. When patients undergo high doses of radiation, their lung needs to be removed, while other treatments allow the lungs to stay in a patient’s body. The overall survival was not as good as the survival for the epithelioid sufferers. The overall survival was 24.4 months while the epithelioid patients had an overall survival of 42.8 months. Biphasic patients had a median overall survival of 18 months.

There can be many different serious side effects when patients undergo SMART. Many patients do not return to a good quality of life until three to six months after the surgery. This makes patients suffer for a large chunk of what little time they have left. Many hospitals usually perform pleurectomy and decortication procedures, allowing patients to keep their lungs and have a shorter recovery time.

There is another surgery procedure called SMARTER, which stands for Surgery for Mesothelioma After Radiation Therapy using Extensive Resection. It uses pleurectomy decortication surgery. It allows more patients to participate because patients who are unable to have their lungs removed can still undergo the treatment. The lungs can remain in patients because the radiation dose that is used is lower. Researchers want to find the best radiation dose that creates an immune response that also does not damage the lungs, which is why the procedure is being studied.

B.C. John Cho et al., “Surgery for malignant pleural mesothelioma after radiotherapy (SMART): final results from a single-centre, phase 2 trial” The lancet Oncology (January 12, 2021). [Link]
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