|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 785-786
Authors' reply to Paramanandhan et al. and Shankar et al.
Adhara Chakraborty1, Shivakumar Thiagarajan2, Devendra Chaukar2
1 Department of ENT, BARC Hospital, Division of Head and Neck Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
2 Department of Surgical Oncology, Division of Head and Neck Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
|Date of Submission||20-Nov-2021|
|Date of Decision||24-Nov-2021|
|Date of Acceptance||30-Nov-2021|
|Date of Web Publication||29-Dec-2021|
Department of Surgical Oncology, Division of Head and Neck Oncology, Tata Memorial Centre, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chakraborty A, Thiagarajan S, Chaukar D. Authors' reply to Paramanandhan et al. and Shankar et al. Cancer Res Stat Treat 2021;4:785-6
We read with interest the letters to the editor by Paramanandhan et al. and Shankar et al. on our article on the sarcomatoid variant of squamous cell carcinoma. We would like to respond to their concerns and queries regarding our article.
Paramanandhan et al. have sought clarifications with regard to the outcomes of patients treated with curative intent, sites of distant metastasis, the association of perineural invasion (PNI) or lymphovascular invasion (LVI) with disease-free survival (DFS), and the time to recurrence and metastasis. We agree that these points require clarifications.
The outcomes of treatment have been described in the article. We used DFS as an endpoint in this article. The DFS of patients who received curative treatment (n = 41) was 76.3 months (95% confidence interval [CI], 60.3–92.4) and that for patients treated with palliative intent treatment (n = 19) was 11.6 months (95% CI, 9.2–14). We have not reported the disease-specific survival (DSS) of patients as per subsite, as the number of patients with disease in other subsites was small. Our primary outcome measure was to understand the stage at presentation (early vs. advanced) and intent of treatment received (curative vs. palliative) along with the secondary endpoint, which was DFS in patients who received curative-intent treatment. In addition, the treatment received across various sites and within subsites was varied. Hence, given the small number of patients for other subsites and the different treatment approaches used, we refrained from reporting the DSS for each separate subsite, as it may not have given us the true picture.
DFS was defined as the duration from treatment initiation to the first recurrence or death, whichever occurred earlier. The time to recurrence was, however, 20.3 months from treatment completion, which included adjuvant treatment. Two patients with recurrence could be salvaged and were alive without disease at the last follow-up, and the rest received palliative-intent treatment (mostly palliative chemotherapy).
Regarding the sites of distant metastasis, a total of nine patients developed distant metastasis, of which three had metastasis at the time of presentation and six developed distant metastasis at the time of recurrence. The majority of the patients had lung metastasis (n = 6), followed by skeletal metastasis (n = 3).
In our study, we did not specify the presence of PNI and LVI as we intended to study the pattern of clinical presentation of this variant of squamous cell carcinoma without the influence of the abovementioned factors. In addition, the treatment received by patients was not uniform, and the numbers were too small to get a meaningful comparison based on the presence or absence of LVI and PNI. However, it cannot be denied that the documentation of LVI and PNI in this variant of squamous cell carcinoma could provide further insights into the need for aggressive management.
Shankar et al. have rightly pointed out that the extent of adjuvant treatment is yet to be decided for this subset of patients. There is still no substantial evidence to allow the use of adjuvant chemoradiation solely based on this histology. Due to our limited sample size, it is difficult to suggest the type of adjuvant treatment that can be provided. In addition to recognizing the clinical pattern of the disease, immunohistochemical markers should be used for histological confirmation.
It is apparent that a shared goal exists among clinicians regarding the need to understand the extent of aggressiveness of this less common variant of squamous cell carcinoma. A rare tumor registry could capture the details of those with sarcomatoid variant of squamous cell carcinoma from across the country to get meaningful numbers to perform further analysis and help answer some of the questions raised by Paramanandhan et al. and Shankar et al.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Paramanandhan M, Anil Kumar MR, Sangeetha KP. Sarcomatoid variant of head and neck tumors: Known is a drop, unknown is an ocean. Cancer Res Stat Treat 2021;4:782-3. [Full text]
Shankar R, Mishra A, Reddy B. Sarcomatoid variant of squamous cell carcinoma of the head-and-neck: Need for aggressive management. Cancer Res Stat Treat 2021;4:783-4. [Full text]
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. [Full text]
Viswanathan S, Rahman K, Pallavi S, Sachin J, Patil A, Chaturvedi P, et al.
Sarcomatoid (spindle cell) carcinoma of the head and neck mucosal region: A clinicopathologic review of 103 cases from a tertiary referral cancer centre. Head Neck Pathol 2010;4:265-75.