1. A single-center phase 2 trial evaluated surgery for malignant pleural mesothelioma after radiotherapy (SMART) in 102 patients with cT1-3N0M0 disease who received radiotherapy followed by extrapleural pneumonectomy within 1 week. 2. After a median follow-up of 46.8 months, the 5-year cumulative incidence of distant recurrence was 62% with the most common sites being the contralateral chest and peritoneal cavity. 3. The results suggest extrapleural pneumonectomy after radiotherapy can be done with good early and long-term results, however minimizing grade 4 post-operative complications remains technically demanding and may affect long-term

1. DR KANHU CHARAN PATRO
M.D, D.N.B[RT], FAROI, MBA, PDCR, CEPC
JUNE 2021 ISSUE/63rd VOLUME
FACE BOOK PAGE
ONCOLOGY CARTOON
PHOTOS
CHAPTER WISE

28. 9th JUNE 2021/LUNG
B C JOHN CHAO /LANCET ONCOLOGY/2021
SURGERY FOR MESOTHELIOMA AFTER RADIOTHERAPY (SMART)
1. Single-centre, phase 2 trial
2. cT1-3N0M0 disease who had previously untreated
malignant pleural mesothelioma were eligible for
inclusion.
3. Patients received 25 Gy in five daily fractions over 1
week to the entire ipsilateral hemithorax with a
concomitant 5 Gy boost to high risk areas followed by
extrapleural pneumonectomy within 1 week.
4. Adjuvant chemotherapy was offered to patients with
ypN+ disease on final pathology.
5. 102 patients were enrolled onto the trial and 96
eligible patients were treated with SMART on protocol
and included in the analysis
6. After a median follow-up of 46·8 months (IQR 13·4-
61·2), the 5-year cumulative incidence of distant
recurrence was 62 (63·3% [95% CI 52·3-74·4]). The
most common first sites of recurrence were the
contralateral chest (33 [46%] of 72 patients) and the
peritoneal cavity (32 [44%]).
7. Results from this study suggest that extrapleural
pneumonectomy after radiotherapy can be done with
good early and long-term results.
8. However, minimizing grade 4 events on the
protocol is technically demanding and might
affect survival beyond the post-operative
period