Suggested links

Mesothelioma SMART

SMART is a new approach to mesothelioma treatment. It involves a standard surgical procedure for pleural mesothelioma called the extrapleural pneumonectomy combined with high radiation therapy known as IMRT. SMART has shown promising results in preventing recurrence and increasing patient survival times.

Fact-Checked and Updated by: Jenna Tozzi, RN

Last updated:

What Is SMART?

Surgery for Mesothelioma After Radiation Therapy, also known as SMART, is a new treatment being studied in clinical trials. Developers of this mesothelioma treatment method use high-dose radiation therapy and then lung-removal surgery to help patients.

Doctors removing the radiated lung and its harmful toxins
Doctors performing surgery on patients’ radiated lung.

Essentially, this treatment method is a reversal of traditional cancer treatments when radiation is administered after surgery. Doctors have recently discovered that treating patients with radiation before surgery confines the disease to the lung and other infected areas.

Through SMART, the microscopic mesothelioma cells, usually left behind after surgery, are killed in the chest cavity. Killing off microscopic cells before surgery prevents seeding, which happens when mesothelioma cells move around during surgery and begin to multiply in distant sites.

Find out how you and your loved ones can access SMART therapy and other treatments in our Free Mesothelioma Guide

Mesothelioma Guide Images
Get Your Free 2024 Mesothelioma Guide
  • Symptoms & staging
  • Average prognosis
  • Life-extending treatments

Get Your Free Guide

Extrapleural Pneumonectomy for SMART Treatment

SMART can only be used with extrapleural pneumonectomy (EPP) surgery. This surgery removes the affected lung, the linings of the lung and heart, and part of the diaphragm.

Prior to surgery, SMART delivers high levels of toxic radiation to the affected lung, meaning doctors must remove it afterward.

The EPP procedure is one of two main surgeries used to treat pleural mesothelioma. The other, pleurectomy with decortication (P/D), spares a patient’s lungs.

How Does SMART Work?

The procedure for SMART follows a specific process:

  1. The patient undergoes intensity-modulated radiation therapy (IMRT) targeted in the chest cavity
  2. After radiation, the patient receives an EPP, removing the lung and surrounding tissues that have a high level of radiation

The radiation used in this treatment is a light-induced therapy in which the beam exposes high doses of radiation in multiple short bursts. This sort of specialized radiation therapy has been discussed as a key component in treating mesothelioma.

Additionally, IMRT targets a single portion of the chest area and uses a computer-controlled device called a linear accelerator, which ensures the radiation flows along a singular path, in order to limit damage to nearby healthy cells.

This treatment is invasive and can only be used on mesothelioma patients who have been approved for complete lung removal. Additionally, only patients who have not yet been treated for mesothelioma are eligible for SMART treatment.

Benefits of SMART for Mesothelioma

The SMART procedure was designed to target pleural mesothelioma tumors and affected surrounding areas while mitigating damage to healthy tissues. High-dose radiation precisely targets cancerous tissue around the lung, leaving less chance of mesothelioma cells spreading to distant sites during the surgery that follows the radiation.

Did You Know?

A 2017 study concluded that SMART on pleural mesothelioma patients showed promising results. Experts found that radiation therapy before an EPP helps contain the tumor. Previous studies showed that administering radiation to patients after an EPP did not have any effect on the survival outcome of patients with mesothelioma.

However, administering focused radiation therapy before surgery is easier on the immune system. It also reduces the chances of recurrence after surgery, giving the patient a better shot at longer survival.

SMART Side Effects

Treating mesothelioma patients with radiation typically puts them at risk of several uncomfortable side effects. These side effects vary from patient to patient and also depend on factors like where the cancer has formed, the patient’s age, and overall health.

However, with SMART therapy targeting tumors so precisely, those who have undergone clinical trials have experienced fewer symptoms than those using traditional radiation methods.

The following are common side effects associated with SMART therapy:

  • Difficulty swallowing
  • Fatigue within a few hours after radiation exposure
  • Temporary cough or shortness of breath
  • Skin irritation near the targeted area, also known as radiodermatitis

Our mesothelioma treatment planner can help you stay on track during cancer treatments. Get our planner now.

Cancer treatment planner
$46.50 value
Limited-Time OfferMesothelioma Treatment Planner
  • Appointment tracker
  • Diet and nutrition tips
  • Tested by over 100 survivors

Get Your Free Planner

Current and Ongoing Research Into SMART

SMART has been in constant evaluation over the years and has seen impressive outcomes in its clinical studies.

One study conducted at Toronto General Hospital concluded that the SMART approach to pleural mesothelioma treatment resulted in a 3-year survival rate of 84% for patients whose cancer was made up of epithelioid cells.

Patients with epithelioid mesothelioma experienced stronger results from SMART than those with biphasic (mixed) mesothelioma — a more aggressive cell type — as those patients only saw a 13% survival increase.

At the time of the study, the average survival rate for pleural mesothelioma was around 12 months, so a high 3-year survival rate is a massive improvement. Furthermore, according to the study, only half of the treated patients required additional chemotherapy after the EPP surgery.

Researchers believe the radiation-first procedure is imperative to preventing the spread of mesothelioma into the chest cavity. They are confident that SMART is a potential breakthrough in long-term treatment for mesothelioma patients.

Seeking Mesothelioma Treatment With SMART

The SMART approach to pleural mesothelioma treatment has so far shown promising results for drastically increasing patient survival times. With its ground-breaking approach to treatment, SMART reduces the risk of local recurrence, allowing patients to live longer with mesothelioma. SMART remains one of the most prominent treatments in expanding research for mesothelioma.

Clinical trials for the SMART approach are currently underway and accepting new pleural mesothelioma patients. If you’re interested in the SMART approach to mesothelioma treatment or other multimodal therapies, contact our Patient Advocates today by calling (866) 608-8933.

Mesothelioma SMART FAQs

Is mesothelioma SMART therapy right for me?

Possibly, yes. Depending on the type of mesothelioma you have and how far it’s spread, SMART therapy may be a good option for you. However, not all patients will qualify.

For best results, ask a mesothelioma specialist if you can receive SMART therapy after a cancer diagnosis, and if it will be the best treatment available in your case.

What is the best treatment for mesothelioma?

Because each patient and case of mesothelioma is unique, the best treatment methods vary for each patient. Thus, some patients can receive SMART therapy and others cannot.

It is important to work with your mesothelioma specialist to determine the best treatment plan for you.

If you need help finding a specialist, explore our Doctor Match program or contact our Patient Advocates at (866) 608-8933.

Are there new treatments for mesothelioma?

Yes. New mesothelioma treatments are emerging every year as doctors and researchers continue to study methods in clinical trials.

SMART, surgery for mesothelioma after radiation therapy, is one of those emerging treatments.

Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

Our Promise to You
Our Promise to You
  1. Communications Biology. (2021). “Blocking the GITR-GITRL pathway to overcome resistance to therapy in sarcomatoid malignant pleural mesothelioma.” Retrieved from: Accessed on December 22, 2022.

  2. Journal of Thoracic Oncology. (2014). “A Feasibility Study Evaluating Surgery for Mesothelioma After Radiation Therapy: The “SMART” Approach for Resectable Malignant Pleural Mesothelioma.” Retrieved from: Accessed on December 22, 2022.

  3. The Lancet Oncology. (2021). “Surgery for malignant pleural mesothelioma after radiotherapy (SMART): final results from a single-centre, phase 2 trial.” Retrieved from: Accessed on December 22, 2022.

Free 30-Minute ConversationWith Jenna Tozzi, RN
Fill Out Your Contact Information
How We Can Help

Mesothelioma Hope is passionate about helping patients and families affected by this aggressive cancer. A mesothelioma diagnosis can be scary and isolating, but we’re here for you at every step. Hope is only a phone call away.

(866) 608-8933
Medical Guidance
  • Get a second opinion
  • Find a doctor or cancer center
  • Access clinical trials
  • Improve your quality of life
Financial Assistance
  • Access $30 billion in trust funds
  • File a mesothelioma claim
  • Increase your VA benefits
  • Apply for travel grants
Supportive Care
  • Find a support group or peer mentor
  • Get help with daily tasks
  • Explore respite care options
  • Navigate life post-treatment