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We completely agree with the first issue raised by Dr. Bölükbas, that video-assisted thoracoscopic surgery (VATS) with drainage of effusions and talc pleurodesis can be sufficient in the context of palliative treatment. We do mention this in our article, albeit with less emphasis, when we mention the use of thoracoscopy with pleurodesis to control symptomatic pleural effusions and lessen pain as a palliative treatment option. Regarding other issues raised we refer readers to the work of Bölükbas and Schirren. They present the possibilities of radical pleurectomy as a surgical therapeutic option in detail. Our review article was intended to familiarize readers with the status quo regarding diagnostic evaluation, occupational health, and possible therapeutic options for pleural mesothelioma disorders. It was not the intention of our article to provide an evaluation and assessment of different therapeutic options. Rather, and we make that explicit in our article, in patients with pleural mesothelioma it is essential to consider and examine the full range of therapeutic options. For this reason it is crucial that the affected patients be referred to specialized institutions where oncology and surgery dovetail in close interdisciplinary collaboration. This is the only way to guarantee that patients receive the best possible treatment, in which the latest surgical techniques, such as radical pleurectomy, are used increasingly, and which may yield further increases in survival times.

We hope that these explanations have alleviated our correspondents’ concerns. For the patients, all attempts at further steps should aim at providing effective treatment, and, ultimately, hopefully curative treatment.

DOI: 10.3238/arztebl.2013.0660b

Dipl.-Biol. Volker Neumann, Dr. rer. nat. Stefan Löseke, Prof. Dr. med. Tannapfel
Deutsches Mesotheliomregister am Institut für Pathologie
der Ruhr-Universität Bochum am Berufsgenossenschaftlichen
Universitätsklinikum Bergmannsheil, Bochum
andrea.tannapfel@ruhr-uni-bochum.de

Prof. Dr. med. Dennis Nowak
Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Munich

Prof. Dr. med. Felix J. F. Herth
Pneumologie und Beatmungsmedizin – Thoraxklinik am Universitätsklinikum, Heidelberg

Conflict of interest statement
Dipl.-Biol. Neumann, Dr. Löseke, Prof. Nowak, and Prof. Tannapfel have served as paid medicolegal consultants for casualty insurance carriers and legal courts for the pathological diagnosis of mesothelioma and the determination of a causal link to asbestos exposure in individual cases.
Prof. Herth states that he has no conflict of interest.

1.
Bölükbas S, Schirren J: Malignes Mesotheliom – Radikale Pleurektomie und extrapleurale Pneumektomie im Vergleich. Chirurg 2013; 83: 487–91. CrossRef MEDLINE
2.
Neumann V, Löseke St, Nowak D, Herth FJF, Tannapfel A: Malignant pleural mesothelioma—incidence, etiology, diagnosis, treatment and occupational health. Dtsch Arztebl Int 2013; 110(18): 319–26. VOLLTEXT
1.Bölükbas S, Schirren J: Malignes Mesotheliom – Radikale Pleurektomie und extrapleurale Pneumektomie im Vergleich. Chirurg 2013; 83: 487–91. CrossRef MEDLINE
2.Neumann V, Löseke St, Nowak D, Herth FJF, Tannapfel A: Malignant pleural mesothelioma—incidence, etiology, diagnosis, treatment and occupational health. Dtsch Arztebl Int 2013; 110(18): 319–26. VOLLTEXT

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