While early findings using the SMART protocol for mesothelioma have been encouraging, replication has proven challenging due to steep surgical learning curves, complexities in planning, and skepticism. Dr. John Cho explores why adoption has been limited and what's next for this approach, which he discussed at the 2025 World Conference on Lung Cancer. Dr. Cho is a radiation oncologist at Princess Margaret Cancer Centre and an Associate Professor in the Department of Radiation Oncology at the University of Toronto.