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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 782-783

Sarcomatoid variant of head.and.neck tumors: Known is a drop, unknown is an ocean


OncoVille Cancer Hospital and Research Center, Bengaluru, Karnataka, India

Date of Submission09-Nov-2021
Date of Decision13-Nov-2021
Date of Acceptance24-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Murali Paramanandhan
OncoVille Cancer Hospital and Research Center, No. 4, 80 Feet Road, 6th Block, 2nd Stage Nagarbhavi, Bengaluru - 560 072, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_272_21

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How to cite this article:
Paramanandhan M, Kumar AM, Sangeetha K P. Sarcomatoid variant of head.and.neck tumors: Known is a drop, unknown is an ocean. Cancer Res Stat Treat 2021;4:782-3

How to cite this URL:
Paramanandhan M, Kumar AM, Sangeetha K P. Sarcomatoid variant of head.and.neck tumors: Known is a drop, unknown is an ocean. Cancer Res Stat Treat [serial online] 2021 [cited 2022 Aug 20];4:782-3. Available from: https://www.crstonline.com/text.asp?2021/4/4/782/334212



The famous couplet, “Known is a drop, unknown is an ocean,” is true in case of medicine and life in general. Variable histological patterns are encountered in most of the tumors. These unknown tumors with variable histology are always a challenge to treat, especially in the absence of standard guidelines. The mainstay of treatment for the sarcomatoid variant is surgery, and it is shown to be associated with better outcomes. Chakaborthy et al. have presented their findings in a concise and well-defined manner and have definitely achieved the objectives of the study.[1] We appreciate the time and energy spent by the team to analyze and publish their experience. However, as the sarcomatoid variant is rare, and the outcomes are generally poor, we would like the authors to consider if it is possible for them to assess the following outcomes of patients treated with curative intent (41 of the 60 patients):

  1. In the present study, out of the 41 patients treated with curative intent, 33 underwent surgery as one of the modalities of treatment; among these, of the 24 patients with oral cavity tumors, 23 were treated with curative intent and had undergone surgery. Hence, it would be better if the outcomes were classified based on the tumor subsite, as done in Bice et al.'s study, where the disease-specific survival for tumors of the oral cavity was better than that for tumors of the oropharynx, larynx, and hypopharynx; additionally, hypopharyngeal tumors had the worst prognosis and presented more commonly with distant metastasis[2]
  2. The authors could consider mentioning the sites of distant metastasis. As per the study by Lambert et al., the lung and soft tissues were the common sites of metastasis[3]
  3. Two prognostic indicators, namely perineural invasion (PNI) and lymphovascular invasion (LVI) are considered to be associated with aggressive tumors and poor prognosis.[4] Therefore, we request the authors to mention in their analysis as to how many of their subjects were found to be positive for PNI/LVI, as these factors affect the disease-free survival (DFS) and are also associated with local recurrence and metastasis
  4. As the present study reported a good DFS in patients treated with curative intent, we would also request the authors to mention the time to recurrence/metastasis. According to Mingo et al.'s study, the time to recurrence was 4 months.[5]


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chakraborthy A, Thiagarajan S, Bal M, Chaukar D. Clinical presentation and pattern of care for sarcomatoid variant of squamous cell carcinoma of the head-and-neck region: A retrospective study. Cancer Res Stat Treat 2021;4:466-71.  Back to cited text no. 1
  [Full text]  
2.
Bice TC, Tran V, Merkley MA, Newlands SD, van der Sloot PG, Wu S, et al. Disease-specific survival with spindle cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2015;153:973-80.  Back to cited text no. 2
    
3.
Lambert PR, Ward PH, Berci G. Pseudosarcoma of the larynx: A comprehensive analysis. Arch Otolaryngol 1980;106:700-8.  Back to cited text no. 3
    
4.
Dai L, Fang Q, Li P, Liu F, Zhang X. Oncologic outcomes of patients with sarcomatoid carcinoma of the hypopharynx. Front Oncol 2019;9:950.  Back to cited text no. 4
    
5.
Mingo KM, Derakhshan A, Abdullah N, Chute DJ, Koyfman SA, Lamarre ED, et al. Characteristics and outcomes in head and neck sarcomatoid squamous cell carcinoma: The Cleveland clinic experience. Ann Otol Rhinol Laryngol 2021;130:818-24.  Back to cited text no. 5
    



This article has been cited by
1 Authors' reply to Paramanandhan et al. and Shankar et al.
Adhara Chakraborty, Shivakumar Thiagarajan, Devendra Chaukar
Cancer Research, Statistics, and Treatment. 2021; 4(4): 785
[Pubmed] | [DOI]



 

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