The rationale for neoadjuvant radiation therapy in malignant pleural mesothelioma: how smart is SMART?

Malignant pleural mesothelioma (MPM) is a rare, aggressive tumour involving the pleura commonly associated with prior asbestos exposure. At present, there is still ongoing debate and controversy regarding its optimal management. In particular, there is no agreed upon consensus as to the most appropriate surgical procedure in this disease with various camps championing extra-pleural pneumonectomy (EPP) on one side and extensive pleurectomy-decortication (EPD) on the other.