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The SMART treatment is one of the most promising forms of multimodal therapy available for patients with pleural mesothelioma.

What is SMART Treatment?

SMART stands for Surgery for Mesothelioma After Radiation Therapy. Doctors call this procedure a multimodal therapy, because it’s a combination of two or more individual procedures, specifically the extrapleural pneumonectomy (EPP) and radiation therapy.

Usually, a multimodal therapy using these two procedures calls for the radiation therapy to be given after the surgery. The SMART procedure, however, is unique because surgeons reverse the traditional order and give radiation therapy before surgery.

How is it Beneficial?

SMART has produced such promising results so far because it addresses one of the main issues posed by the surgical removal of mesothelioma: tumor ‘seeding’ after surgery.

Surgery can be very effective in removing visible portions of a mesothelioma tumor, but is much less effective in removing microscopic mesothelioma cells. These tiny cells often remain in the chest cavity or lungs after surgery and grow into another tumor. This process is referred to as ‘seeding.’

Traditionally, specialists try to kill left-over mesothelioma cells with radiation therapy after surgery. As a rule, they must be very careful with the strength of the radiation they apply, because overly powerful or stray radiation can negatively affect the healthy tissue surrounding the tumor. Too much radiation can make the patient sick.This, however, introduces a problem. The stronger radiation therapy is the more effectively it kills cancer cells and the more likely it is to make the patient sick.

The SMART approach goes a long way to solve this problem. With SMART, specialists can increase the strength of the radiation given to the lung and drastically reduce the amount of exposure to healthy tissue. This is possible because the lung will be removed as part of the EPP after the radiation therapy is applied. If the irradiated lung stayed in the body, it would make the patient sick.

All in all, SMART makes it easier for surgery to more effectively remove mesothelioma from the body.

How does it Work?

e SMART procedure is a combination of two individual treatments: intensity modulated radiation therapy (IMRT) and the extrapleural pneumonectomy (EPP).

IMRT (Intensity Modulated Radiation Therapy)

IMRT is the first part of the SMART procedure. With IMRT, a specialist can control the amount and strength of the radiation beams that are applied to a tumor.

Because the beam is controlled, less radiation is applied to the healthy tissue surrounding the tumor. This means that side effects are drastically reduced and a higher amount of radiation can be applied directly to the tumor. Increasing the amount of radiation allows it to more effectively kill mesothelioma cells.

EPP (Extrapleural Pneumonectomy)

Approximately one week after receiving IMRT, the patient will undergo an EPP. During an EPP, the entire diseased lung is removed along with any visible tumors in the surrounding area. Removing the entire lung reduces the chances of mesothelioma growing back.

SMART Results

A recent clinical trial published in 2014 reported amazing results produced by the SMART approach. All but one of the 25 patients who received SMART were diagnosed with advanced mesothelioma (stage 3 or 4). 84 percent of those patients with epithelioid type mesothelioma experienced a 3-year survival rate.

SMART will undoubtedly improve as researchers perform more testing in clinical trials. As the report cited above demonstrated, clinical trials can greatly benefit patients with advanced mesothelioma, most of whom aren’t often eligible for traditional treatments.

If you’re interested in learning more about how clinical trials can improve your prognosis, speak with our Patient Help Team. A member of our team can review your diagnosis and help connect you to clinical trials that are testing emerging treatments like the SMART approach.