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SMART: Surgery For Mesothelioma After Radiation Therapy

A four year study performed at the at Princess Margaret Cancer Centre in Toronto found that 25 mesothelioma patients who received high dose radiation just before surgery for resection had 50% improved survival, compared to patients who underwent surgery before receiving radiation treatments.

The Surgery for Mesothelioma after Radiation Therapy (SMART) approach was developed by oncologist Dr. John Cho, in collaboration with thoracic surgeon Dr. Marc de Perrot at Princess Margaret Cancer Centre in Toronto, with the aim to kill as many cancer cells prior to surgery as possible, to not only reduce the size of the tumor, but also the risk of the disease spreading to the lung or abdomen as a result of disruption during surgery.

Doctors administered the radiation over the course of five days in the week prior to surgery. The high dose method of administering radiation is made possible through the use of intensity-modulated radiation therapy (IMRT) an advanced mode of radiotherapy allows the radiation to conform more precisely to the three-dimensional (3-D) shape of the tumor, reducing exposure to the heart, spine, and other healthy tissue, and allowing much higher doses of radiation to be administered that traditional methods.

For the 25 patients in the study, the 3 year survival rate more than doubled from 32% to 72%. Patients also experienced fewer complications, a quicker recovery, and a major reduction of the typical treatment cycle from five months down to one month.

Shortening the diagnostic and treatment period for mesothelioma patients is imperative, as a majority of patients diagnosed are given a poor prognosis of only 6 months to live. The SMART approach/protocol makes it possible to control the disease and improve quality of life for potentially several years.

Since completion of the initial study, Drs. Cho and de Perrot have used the SMART approach to successfully treat 20 additional mesothelioma patients. Doctors at the Mayo Clinic in Minnesota will soon begin utilizing the SMART method.

The study is published online in the Journal of Thoracic Oncology.

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