Neoadjuvant hemothoracic intensity modified radiation therapy (IMRT) followed by Extrapleural Pneumonectomy appears to be safe and potentially effective in patients with malignant pleural mesothelioma. Background: With a disease incidence of approximately 3000-4000 cases annually in the United States (US), malignant pleural mesothelioma (MPM) is considered a rare but almost universally fatal malignancy.2 Chemotherapy using pemetrexed combined with cisplatin or carboplatin represents the current standard of care.3 However compared to best supportive care chemotherapy increases median survival only by 3 months.Median survival is 4 to 12 months without treatment and the 2-year overall survival is 0% to 12 %.2 Based on the results of the recently reported MARS study, demonstrating increased mortality and diminished quality of life for patients treated with chemotherapy followed by extrapleural pneumonectomy (EPP) compared to chemotherapy alone4 the therapeutic role for surgical disea...