A trial looking at radiotherapy to prevent spread of mesothelioma after a chest wall procedure (SMART trial)

Cancer type:





Phase 3

This trial looked at the use of radiotherapy to prevent the spread of mesothelioma after having a procedure to the chest wall.

This trial was for people whose mesothelioma started in the two sheets of tissue known as pleural membranes (or pleura) that cover the lungs (pleural mesothelioma). 

More about this trial

When this trial was done, people with pleural mesothelioma  sometimes had radiotherapy to the area where they had a small tissue sample taken or fluid drained.

Some doctors thought this might stop the mesothelioma cells growing in the scar tissue. Radiotherapy was done as soon after the procedure as possible.

Research showed that mesothelioma spreading to the chest wall (a chest wall metastases Open a glossary item) might not be as common as doctors thought. And other studies suggested that having radiotherapy soon after a chest wall procedure might not lower the chances of mesothelioma spreading to the procedure site.

In this trial, researchers compared giving radiotherapy very soon after a chest wall procedure with giving it only if the mesothelioma had spread into or around the scar tissue.

The aims of this study were to:

  • find the best time to give radiotherapy to lower the risk of mesothelioma spreading
  • learn more about side effects, chest pain levels and quality of life Open a glossary item

Summary of results

The trial team found that giving radiotherapy to everyone after a chest wall procedure wasn’t useful and didn’t lower the chances of the mesothelioma spreading to that area.

203 people took part in this trial. They were put into 1 of 2 groups at random.

  • 102 had radiotherapy soon after the chest wall procedure (within 42 days)
  • 101 only had radiotherapy if the mesothelioma spread to the procedure site

Those having radiotherapy had it once a day for 3 days.        

A year after people joined the trial, the trial team looked at the number of people who had developed mesothelioma in the chest wall within 7cm of the procedure site. They found no significant difference between the 2 groups.

They also looked at:

  • quality of life
  • pain scores and how many people reported chest pain or needed pain control drugs

They found no difference between the 2 groups in either of these. The researchers say this suggests that having radiotherapy straight away doesn’t help symptom control.

The main side effects of radiotherapy were:

  • skin reactions such as redness and irritation
  • tiredness

The trial team concluded that having radiotherapy soon after a chest wall procedure wasn’t useful and didn’t prevent the mesothelioma spreading to the procedure site.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Nick Maskell
Dr Amelia Clive

Supported by

NIHR Clinical Research Network: Cancer
NIHR Research for Patient Benefit (RfPB) Programme
North Bristol NHS Trust

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Over 60,000 cancer patients enrolled on clinical trials in the UK last year.

Last reviewed:

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