AM ER IC AN JOURNAL OF OT OLARYNGOLOGY – H E A D A N D NE CK M E D IC IN E A ND S U RGE RY 3 6 (2 0 1 5) 3 12– 3 1 3
Available online at www.sciencedirect.com
ScienceDirect www.elsevier.com/locate/amjoto
Letter to the Editor
Prognostic factors of head and neck sarcomas To the Editor: We read with great interest the recent article by Tajudeen et al. [1] who claimed that their study was “the first report of predictors of survival and recurrence in head and neck malignant peripheral nerve sheath tumor MPNSTs”; they also stated that “prior studies on head and neck sarcomas have consistently shown grade, size, and margin status as prognostic indicators of recurrence and survival”. Given the above, and that the authors aimed at assessing the prognostic factors in patients affected by head and neck sarcomas, we found it not scientifically sounded to include in the study patients with incomplete data. It appears that there were no exclusion criteria applied for the selection of the study population: grade and size of neoplasm were unavailable in a quarter of cases, and the margin status unreported in over 30% of patients. Moreover, variable treatments were performed, and in 10% of cases the authors were not even able to trace the type of treatment that patients had received, and yet they included those patients in the study. Unfortunately, in this way the authors can only report what their experience was, but no information can be extrapolated from this report, bringing therefore very little benefit to the readership. We call for the authors to exclude from the study all patients with missing data in relation to margin status, size, grade and treatment, and to reanalyze whether their conclusions would still hold true. In addition, we read that the majority of cases was treated with a combination of surgery and radio/chemotherapy: given that the most common subtype in the study was a solitary fibrous tumor/hemangiopericytoma (SFT-HPC), surgery alone would have been a preferable treatment. In fact, a recent meta-analysis concerning this particular neoplasm subtype showed that surgery alone is superior to a combined therapy, highlighting an inconsistent relationship between surgical margins and local recurrence or distant metastasis in contrast to a clear correlation with tumor size, histological differentiation and treatment strategy [2,3]. Moreover, the authors may want to separate results for the different subtypes of fibrous tumor/hemangiopericytoma (SFT-HPC) as they may represent different entities with a different behavior [4]. http://dx.doi.org/10.1016/j.amjoto.2014.08.018 0196-0709/© 2015 Elsevier Inc. All rights reserved.
This would also reflect the suggestions to select the most appropriate treatment on the basis of the anatomic subsite of presentation for sarcomas within the head and neck district, as this can improve survival rates [3,5]. Lastly, how could the authors quantify the 5-year recurrencefree survival and overall survival rates if the median follow-up duration was 18.5 months? Did they base their assessment on a limited proportion of the original study sample?
Acknowledgments/disclosure a. Funding/support: none b. Financial disclosures: none for all authors c. Contributions of authors: Design of the study (MC, DD); Conduct of the study (MC, DD, DN); Literature review (MC, MM); Writing of the manuscript (MC, DD, MM); Review of manuscript (MC, DD). d. Other acknowledgments: none REFERENCES
[1] Tajudeen BA, Fuller J, Lai C, et al. Head and neck sarcomas: the UCLA experience. Am J Otolaryngol 2014;35:476–81. [2] Wushou A, Miao XC, Shao ZM. Treatment outcome and prognostic factors of head and neck hemangiopericytoma: A meta-analysis. Head Neck 2014. http://dx.doi.org/10.1002/hed. 23812 [Epub ahead of print]. [3] Sturgis EM. Potter BO Sarcomas of the head and neck region. Curr Opin Oncol 2003;15:239–52. [4] Agaimy A, Barthelmeß S, Geddert H, et al. Phenotypic and molecular distinctness of sinonasal hemangiopericytoma compared to solitary fibrous tumor of the sinonasal tract. Histopathology 2014. http://dx.doi.org/10.1111/his.12452 [Epub ahead of print]. [5] O'Neill JP, Bilsky MH, Kraus D. Head and neck sarcomas: epidemiology, pathology, and management. Neurosurg Clin N Am 2013;24:67–78.
Marco Carifi, MD Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, Naples, Italy Corresponding author at: Department of Otolaryngology
L ET TE R TO THE E DI TOR
Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli” (A.O.R.N. “A. Cardarelli”), Naples, Italy, Via Antonio Cardarelli 9 80131. Tel.: + 39 81 747 1111; fax: +39 81 747 2436 E-mail address: [email protected] Monica Morandi Università degli Studi di Napoli “Federico II”, Naples, Italy Domenico Napolitano, MD Department of Otolaryngology, Azienda Ospedaliera di Rilievo
313
Nazionale “A. Cardarelli” Naples, Italy Danilo Dall’Olio, MD Department of Otolaryngology, Ospedale Maggiore “C.A. Pizzardi" Bologne, Italy 0196-0709 http://dx.doi.org/10.1016/j.amjoto.2014.08.018 © 2015 Elsevier Inc. All rights reserved.
Available online at www.sciencedirect.com
ScienceDirect www.elsevier.com/locate/amjoto
Letter to the Editor
Prognostic factors of head and neck sarcomas To the Editor: We read with great interest the recent article by Tajudeen et al. [1] who claimed that their study was “the first report of predictors of survival and recurrence in head and neck malignant peripheral nerve sheath tumor MPNSTs”; they also stated that “prior studies on head and neck sarcomas have consistently shown grade, size, and margin status as prognostic indicators of recurrence and survival”. Given the above, and that the authors aimed at assessing the prognostic factors in patients affected by head and neck sarcomas, we found it not scientifically sounded to include in the study patients with incomplete data. It appears that there were no exclusion criteria applied for the selection of the study population: grade and size of neoplasm were unavailable in a quarter of cases, and the margin status unreported in over 30% of patients. Moreover, variable treatments were performed, and in 10% of cases the authors were not even able to trace the type of treatment that patients had received, and yet they included those patients in the study. Unfortunately, in this way the authors can only report what their experience was, but no information can be extrapolated from this report, bringing therefore very little benefit to the readership. We call for the authors to exclude from the study all patients with missing data in relation to margin status, size, grade and treatment, and to reanalyze whether their conclusions would still hold true. In addition, we read that the majority of cases was treated with a combination of surgery and radio/chemotherapy: given that the most common subtype in the study was a solitary fibrous tumor/hemangiopericytoma (SFT-HPC), surgery alone would have been a preferable treatment. In fact, a recent meta-analysis concerning this particular neoplasm subtype showed that surgery alone is superior to a combined therapy, highlighting an inconsistent relationship between surgical margins and local recurrence or distant metastasis in contrast to a clear correlation with tumor size, histological differentiation and treatment strategy [2,3]. Moreover, the authors may want to separate results for the different subtypes of fibrous tumor/hemangiopericytoma (SFT-HPC) as they may represent different entities with a different behavior [4]. http://dx.doi.org/10.1016/j.amjoto.2014.08.018 0196-0709/© 2015 Elsevier Inc. All rights reserved.
This would also reflect the suggestions to select the most appropriate treatment on the basis of the anatomic subsite of presentation for sarcomas within the head and neck district, as this can improve survival rates [3,5]. Lastly, how could the authors quantify the 5-year recurrencefree survival and overall survival rates if the median follow-up duration was 18.5 months? Did they base their assessment on a limited proportion of the original study sample?
Acknowledgments/disclosure a. Funding/support: none b. Financial disclosures: none for all authors c. Contributions of authors: Design of the study (MC, DD); Conduct of the study (MC, DD, DN); Literature review (MC, MM); Writing of the manuscript (MC, DD, MM); Review of manuscript (MC, DD). d. Other acknowledgments: none REFERENCES
[1] Tajudeen BA, Fuller J, Lai C, et al. Head and neck sarcomas: the UCLA experience. Am J Otolaryngol 2014;35:476–81. [2] Wushou A, Miao XC, Shao ZM. Treatment outcome and prognostic factors of head and neck hemangiopericytoma: A meta-analysis. Head Neck 2014. http://dx.doi.org/10.1002/hed. 23812 [Epub ahead of print]. [3] Sturgis EM. Potter BO Sarcomas of the head and neck region. Curr Opin Oncol 2003;15:239–52. [4] Agaimy A, Barthelmeß S, Geddert H, et al. Phenotypic and molecular distinctness of sinonasal hemangiopericytoma compared to solitary fibrous tumor of the sinonasal tract. Histopathology 2014. http://dx.doi.org/10.1111/his.12452 [Epub ahead of print]. [5] O'Neill JP, Bilsky MH, Kraus D. Head and neck sarcomas: epidemiology, pathology, and management. Neurosurg Clin N Am 2013;24:67–78.
Marco Carifi, MD Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, Naples, Italy Corresponding author at: Department of Otolaryngology
L ET TE R TO THE E DI TOR
Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli” (A.O.R.N. “A. Cardarelli”), Naples, Italy, Via Antonio Cardarelli 9 80131. Tel.: + 39 81 747 1111; fax: +39 81 747 2436 E-mail address: [email protected] Monica Morandi Università degli Studi di Napoli “Federico II”, Naples, Italy Domenico Napolitano, MD Department of Otolaryngology, Azienda Ospedaliera di Rilievo
313
Nazionale “A. Cardarelli” Naples, Italy Danilo Dall’Olio, MD Department of Otolaryngology, Ospedale Maggiore “C.A. Pizzardi" Bologne, Italy 0196-0709 http://dx.doi.org/10.1016/j.amjoto.2014.08.018 © 2015 Elsevier Inc. All rights reserved.
