A study published on January 20, 2014 in the Journal of Thoracic Oncology, revealed that patients with epithelial mesothelioma responded well to pre-operative radiation in a specialized approach called SMART or Surgery for Mesothelioma After Radiation Therapy. This slower growing type of mesothelioma affects about 70 percent of mesothelioma patients.
What is this new approach? SMART is a reversal of a common treatment that consists of surgery, followed by radiation and occasionally, chemotherapy. While this method has shown a decrease in local recurrence, it requires 5-6 weeks of daily radiation treatment and is difficult for patients after major surgery. SMART treatment begins with radiation and then proceeds to surgery, sometimes followed by chemotherapy.
John Cho, MD, a radiation oncologist at Princess Margaret Cancer Centre in the University Health Network (UHN) in Toronto, Canada led this latest study. Dr. Cho and his team recruited 25 mesothelioma patients, all of which were treated with five days of a special type of radiation called intensity-modulated radiation therapy (IMPT.) This focusses the radiation around the tumor, sparing healthy tissues. Surgery was then performed within a week. Some patients also had chemotherapy following the surgery.
The authors of the study reported, “At three years, the cumulative survival reached 84 percent and disease-free survival 65 percent in patients with epithelial histologic subtype.” Fatigue, nausea, and an inflamed esophagus were the primary side effects.
Benefits This approach shortened treatment time, and also blocked the ability of the cancer to spread and seed itself elsewhere in the body during surgery. “These research results offer real hope to mesothelioma patiens who have too often been told in the past that they may have only six months to live,” remarked Dr. Marc de Perrot, professor of surgery at the University of Toronto and head of the Toronto Mesothelioma Research Program.
David Horvick, MD, a radiation oncologist with 21st Century Oncology of New Jersey, said additional study of this approach is needed to confirm these findings. “The preoperative regimen described in this study was very tolerated, required only one week of treatment, and resulted in good survival rates. Further evaluation of the regimen is indicated,” he said.
What is mesothelioma? Mesothelioma is primarily caused by exposure to asbestos, banned in the U.S. since the late 1970s. However, because of a long latency period – up to 50 years – people exposed in the past are still contracting this horrific disease. It is a malignancy that generally begins in the lining that surrounds the lungs, but can also begin in other internal organs.
Candidates for SMART treatment should be diagnosed in the early stages of the disease. If you believe you or a loved one have been exposed to asbestos or if you’re experiencing shortness of breath, let your doctor know so you can be monitored for symptoms and begin early treatment.