Malignant Pleural Mesothelioma: Present Status and Future Directions

Malignant pleural mesothelioma is a life-threatening neoplasm of the mesothelium, the layer of tissue that covers many organs in the human body. The incidence of this type of neoplasm is gradually ...
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Surgical Treatment after Radiotherapy in Malignant Pleural Mesothelioma

Pp. 441-451 (11)

Laura Donahoe and Marc de Perrot


alignant Pleural Mesothelioma (MPM) is a diagnosis that implies a poor prognosis and lack of effective treatment options. As a consequence of the lag time between exposure to asbestos and onset of disease, the incidence of MPM is expected to keep rising in the coming years. Although many treatment algorithms have been tried in the past, mortality is still very high due to both high local recurrence rates and development of distant disease. A new protocol was thus developed in an attempt to improve overall survival from this disease - Surgery for Mesothelioma After Radiation Therapy (SMART). The SMART involves a fractionated administration of 25 Gy over seven days to the whole chest by intensity modulated radiation therapy (IMRT). A concomitant boost of 5 Gy is also delivered to high risk volumes - based on imaging findings (CT and PET). Within 15 days of the completion of the radiation treatment, therapy, extra-pleural pneumonectomy is performed. This protocol may yield satisfactory results in case of epithelial-type MPM.


Hemithoracic radiation, radiotherapy, thoracic surgery.


Toronto Mesothelioma Research Program, Toronto General Hospital Princess Margaret Cancer Center, 200 Elizabeth street, Toronto, Canada.