Finding the right treatment protocol for the treatment of malignant pleural mesothelioma is an ongoing project, with researchers around the world working diligently to identify the correct combination of treatments, in the right order, to deliver the best overall survival. A recent study published in the renowned journal The Lancet Oncology has revealed that patients undergoing the most aggressive surgery after receiving radiation therapy are experiencing positive outcomes both in the short-term and the long-term.
SMART Technique Continues to Deliver Promising Outcomes
The combination of surgery for mesothelioma after radiation therapy is referred to by the acronym SMART, and it has been the focus of a significant amount of scientific inquiry. This most recent study followed patients with previously untreated malignant pleural mesothelioma who first had radiotherapy and then the more physically demanding, aggressive mesothelioma surgery known as extrapleural pneumonectomy, which includes removal of an entire lung and pleural tissue along with lymph nodes and part of the diaphragm.
Though extrapleural pneumonectomy is the most radical and invasive surgery used in the treatment of mesothelioma, it has proven successful in patients who are strong enough to physically withstand its rigors. This latest study found that the success of the combination of surgery and radiation therapy yields good results, but requires that patients are treated at centers that offer high levels of skills and experience in order to meet the potential adverse post-operative effects. The researchers write, “SMART has achieved the best results in a large prospective surgical trial for malignant pleural mesothelioma in terms of overall survival. However, SMART requires surgical and radiation expertise to achieve optimal results and should not be adopted outside of expert centers with substantial surgical experience.”
Eleven-Year Study Showed Positive Long-Term Effect of SMART Protocol
There were 96 mesothelioma patients treated between November 1, 2008 ad October 31, 2019 included in the study. Each patient received radiotherapy and then surgery between 2 and 12 days later. Almost half the patients had significant adverse perioperative effects within the first month, with one dying of grade 5 pneumonia. Following the short-term period, the patients were followed over a five-year period, with 17 showing a cumulative incidence of local recurrence and 62 experiencing a cumulative incidence of distant recurrence of their disease.
The researchers discussed the short-term outcomes, saying that patient selection and the site of service have a significant impact on outcome. “The results emphasize the importance of patient selection. [Thirty]day grade 4 complications are an independent factor affecting long-term survival after extrapleural pneumonectomy, even though most patients survived their complications. Although careful patient evaluation and selection for extrapleural pneumonectomy is obvious, the detrimental effects of grade 4 complications on overall survival had not been reported previously, and might explain the variable outcomes between surgical series.”
Extrapleural pneumonectomy is just one of the options available to patients diagnosed with malignant mesothelioma. For information on outstanding treatment, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.