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Mesothelioma Survivors

Despite mesothelioma being an aggressive cancer, there are many patients who have lived long, fulfilling lives after getting diagnosed. The sooner you get diagnosed and treated, the better your chance of living past your initial prognosis. Read about mesothelioma survivors who’ve defied the statistics, including some patients who’ve lived for over 20 years with this cancer.

Medically reviewed by: Mark Levin, MD

Last updated:

Can You Survive Mesothelioma?

Even though the average life expectancy for mesothelioma is 12-21 months, some survivors of mesothelioma have lived well beyond their prognosis (projected health outlook).

If you or a loved one has been diagnosed with mesothelioma, you may be able to achieve long-term survival by receiving specialized treatments, participating in clinical research trials, and making good nutritional choices. There are also emerging mesothelioma treatments that may increase your odds of survival.

The first step in becoming a mesothelioma survivor is to see a specialist who can develop a custom treatment plan to improve your mesothelioma prognosis and possibly increase your life expectancy.

Get your Free Mesothelioma Survivors Guide today to get tips from mesothelioma survivors and their loved ones.

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  • Tips for fighting mesothelioma
  • Navigating life after treatment

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Stories of Hope: Read About Mesothelioma Survivors

While there is no cure for mesothelioma, advancements in cancer research and treatment are helping patients achieve long-term survival. Read about some of these mesothelioma survivors below.

Alexis Kidd

  • Diagnosis: Peritoneal mesothelioma
  • Year of Diagnosis: 2007
  • Treatment: Surgery with heated chemotherapy

Alexis Kidd was only 37 years old when she learned she had peritoneal mesothelioma during a routine follow-up appointment for gallbladder surgery. The news took her breath away.

Abruptly, she went from a busy thirtysomething with two jobs and an active social life to a shocked young woman who was told she had anywhere from 6 months to 2 years to live.

Thankfully, Alexis found a skilled surgical team at MD Anderson Cancer Center in Houston that did everything in its power to save her life. Her team even worked alongside mesothelioma specialist Dr. Paul Sugarbaker to learn how to perform his pioneering hyperthermic intraperitoneal chemotherapy (HIPEC) procedure.

Over the last 16-plus years, Alexis has drawn inspiration from a support system that includes her husband and friends as well as fellow mesothelioma survivors.

“The mesothelioma community has afforded me an incredible opportunity to meet others who have either been diagnosed with this same type of cancer or who have a family member battling this illness.”

- Alexis Kidd, Peritoneal mesothelioma survivor

John Stahl

  • Diagnosis: Stage 4 pleural mesothelioma
  • Year of Diagnosis: 2019
  • Treatment: Chemotherapy

The story of mesothelioma survivor John Stahl is nothing short of awe-inspiring. Just as he and his wife, Dee, were preparing to enjoy their golden years in Nevada, John was diagnosed with stage 4 pleural mesothelioma. This is the most advanced stage of this cancer and has a median life expectancy of 12 months.

Pleural Mesothelioma Survivor John Stahl Video Thumbnail

Mesothelioma survivor John Stahl was diagnosed with stage 4 pleural mesothelioma in 2019. More than four years later, he's still enjoying his golden years with his wife, Dee. Call us today at (866) 608-8933 to get the medical help you need to become a survivor. View Transcript.

Duration: 2 min 59 sec

Dee Stahl:
The day started out fine. We got up and John, which is unusual for him, just came out of the bedroom and just sat down, and he said, “I just don’t feel good.” And I knew something was wrong because John doesn’t complain. And I said, “Well, I think we should probably go to the ER.” They found out that there was over two liters of fluid on his left lung, and they were amazed that he was even able to breathe, period. They did a CAT scan, and that’s when he just said, “You have stage four mesothelioma, John.”

John Stahl:
I was kind of blank. I didn’t know what to think. I didn’t realize that my job had exposed me to this.

Dee Stahl:
We’re the Stahls. I’m Dee, and this is my husband, John.

John Stahl:
My name is John Stahl. I was first exposed to asbestos poisoning through the construction business, through Sheetrock®, through gaskets, and piping all through my career. And I worked 43 years in the construction business. If you don’t work, you don’t get paid. The first treatment was with chemotherapy, and I went every two weeks. It didn’t take long, an hour or so, but it would take me seven to 10 days to recover. That was hard for me because I’m a pretty active person. At first, it didn’t really sink in. The longer I thought about it, it’s gonna end my life eventually, but I’m gonna live it…as well as I can.

Dee Stahl:
Being with John through this, I’m glad I was here for him. He’s got a lot of support. He’s got a lot of friends and family that really care for him. But to be there, John made it easy because he was so positive. I’m just glad I was here for him. He held me up, really.

John Stahl:
Having Dee with me going through this was indescribable. It’s important for people to understand that there’s help and there’s people that are willing to help them.

Dee Stahl:
I think John’s positive attitude has kept him going like he has, having John so halfway healthy. I mean, he’s able to do things and be happy. John’s a very positive guy. He makes you happy.

He traced his cancer back to the construction industry, where he spent four decades working with drywall, gaskets, and other asbestos-containing products.

Since John’s cancer was too advanced for surgery, his mesothelioma specialist recommended chemotherapy. The long recovery period between his biweekly treatments was hard on John, who was used to staying active.

Amazingly, however, he is now back to playing golf twice a week and driving through the scenic red-rock canyons of Nevada, Utah, and Arizona with Dee by his side.

Julie Gundlach

  • Diagnosis: Peritoneal mesothelioma
  • Year of Diagnosis: 2006
  • Treatment: Surgery with heated chemotherapy

St. Louis native Julie Gundlach is a nationally recognized mesothelioma survivor who has been living with this cancer since she was 35. Her father spent 40 years as an electrician and carried asbestos home on his clothing each day, unaware that the tiny fibers could be tracked through the house and cause cancer if inhaled.

Just one year after her father died from asbestos-related lung cancer, Julie received her own diagnosis: malignant peritoneal mesothelioma. She was given 6-12 months to live.

Julie was determined to fight her disease so she could be a part of her 3-year-old daughter’s life. After five intensive cytoreduction surgeries with HIPEC, Julie’s mesothelioma is now stable.

In 2022 —16 years after being told by doctors that she shouldn’t expect to make it more than a year — Julie was able to see her daughter off to college.

“That is, without a doubt, a miracle. Getting to see a life that I never thought I’d see.”

- Julie Gundlach, Peritoneal mesothelioma survivor

Throughout her cancer journey, Julie has found support from groups that advocate for mesothelioma patients. She is an outspoken advocate for a complete ban on asbestos and serves as an ambassador for the Asbestos Disease Awareness Organization (ADAO) to help educate the public about asbestos exposure.

Arthur Putt

  • Diagnosis: Pleural mesothelioma
  • Year of Diagnosis: 2018
  • Treatment: Chemotherapy and immunotherapy combined with alternative treatment

Mesothelioma survivor Arthur “Art” Putt and his wife, Jan, are proud to have proven the naysayers wrong. When Art was diagnosed with pleural mesothelioma, his prognosis was grim.

“Originally, the doctor said he would have possibly six months to a year, and that was four years ago. I still got him.”

- Jan Putt, Wife of pleural mesothelioma survivor Art Putt

Art’s specialist started him on chemotherapy and then switched to immunotherapy for better results. Both treatments helped for a time, but Art’s doctors found they became less effective as his cancer spread. On the suggestion of his wife and daughter, both of whom are nurses, Art decided to incorporate alternative treatment in the form of an anti-inflammatory diet.

Twice a day, Jan prepares a blend of asparagus, beetroot powder, cottage cheese, and various oils for Art to drink. He credits the mixture for helping him feel as healthy as he does today.

Learn more about Art’s journey to survival — along with other stories of patients who’ve defied the odds — in our Free Mesothelioma Survivors Guide.

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How We Can Help You Survive Mesothelioma

The Mesothelioma Hope team will do everything we can to help you become a survivor.

Our compassionate Patient Advocates can:

  1. Help you get a second opinion for an accurate diagnosis
  2. Connect you with leading mesothelioma specialists and cancer centers
  3. Look for financial assistance to help you pay for medical treatments
  4. Provide emotional support for you and your loved ones

Contact us today to get started.

Factors That Impact Mesothelioma Survival

There are a range of factors that affect whether some mesothelioma patients live longer than others. Certain factors are out of your control, such as your age, what type of mesothelioma you have, and the cancer’s stage at the time of diagnosis.

Time of Diagnosis and Mesothelioma Stage

Getting an early diagnosis is key to achieving remission and becoming a mesothelioma survivor. Be sure to visit a mesothelioma specialist as soon as you start experiencing symptoms. The earlier you are diagnosed with mesothelioma, the more treatment options you will have.

Stages 1 and 2 of mesothelioma can often be treated with surgery since the cancer is localized to one area. By the third and fourth stages of mesothelioma, tumors may have spread to distant parts of the body, and it may not be possible to surgically remove all traces of cancer.

In rare cases, some stage 3 and stage 4 patients have achieved remission with medical treatment or lived far beyond their prognosis, such as pleural mesothelioma survivor John Stahl.

Specialized Treatments

Patients whose cancer hasn’t spread far beyond the lungs or abdomen may be eligible for specialized treatments for mesothelioma, including surgery, chemotherapy, and radiation.

For instance, cytoreductive surgery with HIPEC, also known as hot chemotherapy, has allowed many peritoneal mesothelioma patients to live considerably longer with fewer symptoms. Unlike standard chemotherapy, which requires multiple treatments over several weeks, HIPEC is a single surgical procedure that allows doctors to deliver a more concentrated dose of chemotherapy to the abdominal cavity.

“HIPEC is quite unique in combating cancer and getting improved outcomes for patients who often only had months to live. We are getting patients that usually survive only months and are now living multiple years.”

- Quote from Dr. Daniel Labow, peritoneal mesothelioma specialist at Nuvance Health

Disease Management and Clinical Trials

After receiving specialized treatments, mesothelioma survivors are encouraged to keep meeting with their doctor regularly to keep their cancer in check. This is called disease management. During these follow-up visits, mesothelioma survivors can report any new symptoms or concerns so their specialist can act swiftly to address them.

Additionally, new and emerging treatments being tested in mesothelioma clinical trials can also impact survival. If there is enough clinical evidence that emerging treatments (like gene therapy, immunotherapy, and targeted therapy) can help mesothelioma patients live longer, they may be approved for widespread use.

In March 2023, for example, Merck and the Canadian Cancer Trials Group shared preliminary study results showing that the immunotherapy drug pembrolizumab (KEYTRUDA®) is helping patients with pleural mesothelioma survive significantly longer when added to chemotherapy. This combination seems to be more effective for pleural mesothelioma patients than chemotherapy alone.

Not sure if you qualify for clinical trials and emerging treatments? Get our Free Checklist of Questions to Ask Your Doctor and bring it with you to your next appointment.

Age and Overall Health at Diagnosis

Older mesothelioma patients generally have lower survival rates than younger patients.

More than half of patients diagnosed before age 50 live one year, but less than 30% of patients who are 75 years or older live the same amount of time, according to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program.

Younger patients have higher survival rates as they usually are better candidates for major cancer surgeries.

Older patients may be unable to undergo major treatments if they’re in poor overall health, have a weakened immune system, or are at higher risk of medical complications.

Mesothelioma Survivors Diet and Nutrition

Nutrient-rich foods can help mesothelioma patients maintain the physical strength to withstand major treatments that can also extend their lives.

Top hospitals and treatment centers often have dietitians on staff who can prepare a personalized mesothelioma cancer survivors diet, which will typically include a large amount of protein to help retain muscle and promote cell repair.

How to Become a Mesothelioma Survivor

There’s no guaranteed way to become a mesothelioma survivor, but there are some steps you can take to improve your prognosis.

Get a Second Opinion

Every mesothelioma patient has the right to ask for a second opinion about their diagnosis and treatment options. Getting a second opinion can help ensure you’re getting the right treatment to help you become a mesothelioma survivor.

Second opinions are highly recommended since mesothelioma is often misdiagnosed at first. This may give the cancer more time to spread and reduce your odds of long-term survival.

Our Patient Advocates help you or a loved one get a second opinion. Call (866) 608-8933 right now to get started.

Find a Specialist

Many mesothelioma survivors have said that finding the right mesothelioma doctor was the most important decision they made on their journey to survivorhood. You should seek out a specialist with experience treating your specific type of mesothelioma. Some specialists, like Dr. Robert Cameron and the late Dr. David Sugarbaker, have pioneered new treatments to help patients live beyond their prognosis.

A mesothelioma specialist can develop a personalized treatment plan based on your diagnosis and help manage any side effects along the way. They can also see if you’re eligible for emerging treatments, including ones only available in clinical trials.

We can connect you with top specialists near you — use our Free Mesothelioma Doctor Match now to get started.

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Seek Emotional Support

Developing a strong support system is key to maintaining a positive outlook and quality of life while battling mesothelioma. This might include seeing a licensed counselor, attending mesothelioma support groups to meet other patients and survivors, or talking to friends and family.

Don’t be afraid to ask for help. There are a variety of emotional support resources to meet your personal needs and preferences.

How to Become a Mesothelioma Survivor Video Thumbnail

Mesothelioma is a life-threatening cancer but many patients have become long-term survivors, living for 20 years or more in some cases. Getting treatment from a specialist may help you become a survivor.

Duration: 00 min 55 sec

Remission and Mesothelioma Survivors

What sets survivors apart from other patients with this aggressive cancer is that they often achieve mesothelioma remission.

When cancer is in remission, the tumors either fully disappear or shrink, allowing patients to live with fewer or no symptoms.

There are two types of remission: full and partial.

  • Full remission: This occurs when a patient has no evidence of disease (NED). NED describes the state when all visible traces of cancer are gone from the body. Mesothelioma survivor and peer mentor Mary Jane Williams was cancer-free for 15 years after treatment.
  • Partial remission: This happens when mesothelioma tumors have been reduced by 50% or more. Specialists may be able to treat mesothelioma more easily, even if the cancer isn’t fully gone.

Mesothelioma survival is directly related to the achievement of remission through treatment. Studies across various cancer centers have found an overall median survival rate of about 4.5 years and a maximum rate of 19.5 years for patients who achieve remission through treatment.

Some mesothelioma survivors, such as Julie Gundlach, have also been able to reach “stable disease,” which is a term used to describe cancer that has not changed (tumors are neither growing nor shrinking).

Learn more about Mary Jane, Julie, and other inspiring patients who have surpassed their life expectancy in our Free Mesothelioma Survivors Guide.

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Remembering Mesothelioma Survivors We’ve Lost

Mesothelioma Hope is honored to share the stories of mesothelioma survivors who will be forever remembered for their strength and resilience.

Mary Jane Williams

  • Diagnosis: Peritoneal mesothelioma
  • Year of Diagnosis: 2003
  • Treatment: Surgery, chemotherapy, and radiation

Mary Jane Williams was diagnosed with peritoneal mesothelioma in 2003 after gallbladder surgery. With support from her husband, she immediately took action and visited three mesothelioma specialists before choosing to travel to New York for treatment.

Mary Jane bravely underwent two major surgeries, chemotherapy, and radiation therapy over a series of 43 trips between Ohio to New York. She also served as a mentor for other mesothelioma patients, accompanying them to their frequent hospital visits to offer emotional support.

An advocate until the very end, Mary Jane survived mesothelioma for 15 years before passing away from Alzheimer’s disease in 2018.

Mike Matmuller

  • Diagnosis: Pleural mesothelioma
  • Year of Diagnosis: 2011
  • Treatment: Surgery and chemotherapy

Mike Matmuller was diagnosed with pleural mesothelioma at just 29 years old and was told he had less than a year to live. However, after four rounds of chemotherapy and a mesothelioma surgery known as an extrapleural pneumonectomy (EPP), Mike was declared cancer-free.

After his treatments, Mike and his wife were able to have a baby girl in 2016. Mike’s daughter motivated him to dedicate his life to advocating for more research funding to find a cure for mesothelioma.

“We bravely decided to start our family and not let the fear of this horrible disease stop us from our dreams.”

- Mike Mattmuller, 9-year pleural mesothelioma survivor

Mike ultimately lost his courageous battle with mesothelioma in 2020. Today, he is remembered for his legacy of fierce advocacy for mesothelioma victims.

Walter Twidwell

  • Diagnosis: Pleural mesothelioma
  • Year of Diagnosis: 2017
  • Treatment: None

Mesothelioma survivor Walter Twidwell was a U.S. Navy veteran who developed cancer decades after serving in the Korean and Vietnam wars.

U.S. Navy Veteran Walter Shares His Story Video Thumbnail

Walter, a U.S. Navy veteran with mesothelioma, shares how he was exposed to asbestos and explains how filing a claim for legal compensation helped him. View Transcript.

Duration: 3 min 12 sec

I am spitting polished, I’ll tell you not. I was proud I was in the Navy on seven ships, I was a boiler tender and when I want to board ship that’s when I found out that was as best in the products. Nobody ever said anything about it being dangerous. It didn’t kill anybody on the spot, that’s for sure but it took years later. When started catching up with us but the word mesothelioma, I didn’t know anything about when I turned 70, I started getting pneumonia, not a flu but pneumonia once in a while but then as time went on they kept getting closer and closer and closer together and asked the doctor, I said, I want to know why and they sent me downstairs get a chest X-ray and made it back before I got back up there. I really can’t explain it it I got a knot in my stomach you know but he told me then that there was no care for it he said you have all your paperwork in order I said yes I do he said well keep it there so oh I can’t cut wood or anything any re a big Garden or anything anymore I was been so independent all my life and all of a sudden I can’t do anything for myself. I’m very weak short breath and I’ve lost a lot of weight I’m a little angry about it if I can have my health back I’d give it back give have money back. The thing what convinced me about carrying on with a lawsuit was when I was informed that I wasn’t suing the government, I wasn’t suing the US Navy, I was going suing the manufacturer and I got mad then because they knew when I got told they knew many years prior what it would do to the human being I got mad I said well heck with this noise they’re going to hear from me there was a couple lawyers coming out from from the the law firm Simmons. It was only two or 3 days and he was here I was surprised at the stuff that he knew he just knows the names of all the pumps and the valves going clear back way you know it was a hands-on approach. I guess and that’s what drew me because that’s the way I do things hands-on approach they were prepared they could go back to day one and I appreciated that they damn well earned it.

His work as a boiler tender and fireman on several U.S. Navy ships put him into direct contact with products that contained asbestos fibers. He was diagnosed with pleural mesothelioma in his right lung and instructed by his doctor to make sure his end-of-life plans were in order.

Still, the grim news only strengthened his resolve. He filed a mesothelioma lawsuit against Goodyear, the company that manufactured the asbestos-containing gaskets that caused his cancer, and a jury awarded him $40 million in 2018.

Even though he decided not to get chemotherapy, Walter survived for two-and-a-half years with mesothelioma before he passed away in 2019.

Get Help Becoming a Mesothelioma Survivor

No one deserves cancer — especially when it’s caused by everyday products that you thought were safe to use. However, as we’ve learned by speaking with numerous mesothelioma survivors, there is always hope.

You may be able to become a long-term mesothelioma survivor by working with top specialists and exploring proven treatment methods.

Learn how several patients have lived years with this cancer — request our Free Mesothelioma Survivors Guide today to read their inspiring stories of hope and resilience.

Disclaimer

Nontraditional and alternative treatments should only be pursued under the supervision and guidance of your specialist.

Mesothelioma Survivors FAQs

Has anyone ever survived mesothelioma?

Yes. Many mesothelioma patients have survived the disease and outlived their initial prognosis using traditional and emerging treatments.

Generally speaking, the earlier mesothelioma is detected, the longer a patient can live.

What is the longest someone has lived with mesothelioma?

Diagnosed in 1997 at age 52, Paul Kraus is currently the longest-living mesothelioma survivor in the world. Doctors thought Paul would only live for six months, but he has been able to survive for more than 25 years since his mesothelioma diagnosis.

Is mesothelioma always terminal?

While mesothelioma is a terminal disease, it is not an automatic death sentence.

The medical community continues to develop more sophisticated methods to diagnose and treat mesothelioma. As a result, some victims have survived for years without their cancer coming back.

If you or a loved one think you have mesothelioma, it’s important to find a specialist who can can provide an accurate diagnosis and design the right treatment plan for you.

Dr. Mark LevinReviewed by:Mark Levin, MD

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD, has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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References
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  2. American Cancer Society. (2019, May 28). What’s new in malignant mesothelioma research. Retrieved February 5, 2024, from https://www.cancer.org/cancer/malignant-mesothelioma/about/new-research.html
  3. Business Wire. (2023, March 10). KEYTRUDA® (pembrolizumab) plus chemotherapy significantly improved overall survival versus chemotherapy alone as first-line treatment for advanced malignant pleural mesothelioma. Retrieved February 5, 2024, from https://www.businesswire.com/news/home/20230310005060/en/
  4. Canadian Cancer Society. (n.d.). Survival statistics for mesothelioma. Retrieved February 5, 2024, from http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/prognosis -and-survival/survival-statistics/?region=on
  5. Cancer Research UK. (2021, May 28). Mesothelioma survival. Retrieved February 5, 2024, from www.cancerresearchuk.org/about-cancer/mesothelioma/survival
  6. Dawson-Rose, C. et al. (2016). Building trust and relationships between patients and providers: an essential complement to health literacy in HIV care. Journal of the Association of Nurses in AIDS Care. Retrieved February 5, 2024, from https://www.sciencedirect.com/science/article/pii/S1055329016300012
  7. Gutiontov, SI. (2019, December 26). The median isn’t the message: revisited. J Clin Oncol. Retrieved February 5, 2024, from https://pubmed.ncbi.nlm.nih.gov/31877084/
  8. Moffitt Cancer Center. (n.d.). Mesothelioma clinical trials. Retrieved February 5, 2024, from https://moffitt.org/cancers/mesothelioma/treatment/clinical-trials/
  9. MD Anderson Cancer Center. (n.d.). Hyperthermic intraperitoneal chemotherapy. Retrieved February 5, 2024, from https://www.mdanderson.org/treatment-options/hyperthermic-intraperitoneal-chemotherapy.html
  10. Mesothelioma Applied Research Foundation. (2022, May 11). “My biggest fear was that my daughter wasn’t going to remember her mother.” Retrieved February 5, 2024, from https://www.curemeso.org/2022/05/11/my-biggest-fear-was-that-my-daughter-wasnt-going-to-remember-her-mother/
  11. Moffitt Cancer Center. (n.d.). Mesothelioma recurrence. Retrieved February 5, 2024, from https://moffitt.org/cancers/mesothelioma/recurrence/
  12. National Cancer Institute SEER Explorer. (n.d.). SEER 5-year relative survival rates, 2012-2018. Retrieved February 5, 2024, from https://seer.cancer.gov/statistics-network/explorer/application.html?site=111&data_type=4&graph_type=5&compareBy=sex&chk_sex_3=3&chk_sex_2=2&series=9&race=1&age_range=1&stage=101&advopt_precision=1&advopt_show_ci=on&advopt_display=2
  13. Neuwirth, M., Alexander, H. & Karakousis, G. (2016). Then and now: cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), a historical perspective. Journal of Gastrointestinal Oncology. Retrieved February 5, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754315/
  14. Rusch, V.W. & Venkatramen, E. (1996). The importance of surgical staging in the treatment of malignant pleural mesothelioma. Journal of Thoracic and Cardiovascular Surgery, 111, 815-826. Retrieved February 5, 2024, from https://pubmed.ncbi.nlm.nih.gov/8614142/
  15. Shavelle, R., Vevra-Musser, K., Lee, J. & Brooks, J. (2017, January 23). Life expectancy in pleural and peritoneal mesothelioma. Lung Cancer International. Retrieved February 5, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/
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