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LETTER TO THE EDITOR
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 211-212

Clarifications concerning the case report on "extra-skeletal ewings sarcoma of the sinonasal tract"


1 Department of Pathology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
2 Department of Radiology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
3 Department of ENT, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India

Date of Web Publication23-Apr-2014

Correspondence Address:
Y Sunil Kumar
Department of Pathology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131436

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How to cite this article:
Kumar Y S, Ninan K, Bhandary SK, Kishan Prasad H L, Shetty K J, Makannavar J H. Clarifications concerning the case report on "extra-skeletal ewings sarcoma of the sinonasal tract". J Can Res Ther 2014;10:211-2

How to cite this URL:
Kumar Y S, Ninan K, Bhandary SK, Kishan Prasad H L, Shetty K J, Makannavar J H. Clarifications concerning the case report on "extra-skeletal ewings sarcoma of the sinonasal tract". J Can Res Ther [serial online] 2014 [cited 2019 Sep 17];10:211-2. Available from: http://www.cancerjournal.net/text.asp?2014/10/1/211/131436

Sir,

We the authors of the article titled "Rare case of extra-skeletal Ewings sarcoma of the sinonasal tract" published in January-March issue 2012, appreciate the queries raised by our fellow colleagues in the issue October-December 2012. [1] In response to their letter titled Requesting clarifications concerning the case report on"extra-skeletal Ewing sarcoma of the sinonasal tract," we would like to give the following clarifications. [2]

  1. Regarding the query, whether the tumor is osseous or extraosseous, on studying multiple axial and coronal computed tomography sections of the nose and paranasal sinuses, we noticed that major bulk of the tumor was situated in the right nasal cavity and maxillary antrum. However, little bony erosions were seen only in the posterior and medial aspect of right maxillary antrum without destruction or infiltration of the bone. Even on excision, the tumor was easily removed enmasse like a polyp from the eroded area. On microscopy also, no bony tissue were seen infiltrated by the tumor. Hence, the diagnosis of " extra-skeletal sinonasal Ewing's sarcoma" was offered. However, both osseous and extraosseous sinonasal Ewings sarcoma with this clinical presentation has similar treatment [1]
  2. Regarding chemotherapy, 14 cycles of vincristine, adriamycin and cyclophosphamide were given alternated with ifosfamide and etoposide. After 10 cycles, adriamycin was replaced with D-actinomycin to prevent cardiotoxicity of the former. This regime is called the VACA-IE regime (vincristine, adriamycin, cyclophosphamide, D- actinomycin- ifosphamide, etoposide) Our patient tolerated chemotherapy very well [3]
  3. Regarding radiotherapy, a total dose of 50 Gy was administered at 2 Gy/day for 5 days in a week for 5 weeks continuously. [4] The radiotherapy technique used was intensity guided radiation therapy with linear accelerator machine; however, 3D image guided radiation therapy can also be used. [4] Careful precautions were taken to safeguard the adjacent vital structures such as eye, brainstem, optic nerve and chiasma. Patient tolerated radiotherapy very well and after completion of the entire dose, the gross tumor volume reduction was more than 90%. Post-treatment surgical resection was not done, since the patient was not willing. However, on regular follow-up, she is asymptomatic and doing well without any recurrence or metastasis.



 > Acknowledgments Top


We would like to thank (1) Dr. Padmapriya, Associate Professor of Pathology, KMC Manipal, (2) Dr. Harish S Permi, Associate Professor of Patholoogy, Kshema.



 
 > References Top

1.Yeshvanth SK, Ninan K, Bhandary SK, Lakshinarayana KP, Shetty JK, Makannavar JH. Rare case of extraskeletal Ewings sarcoma of the sinonasal tract. JCancerResTher 2012;8:142-4.  Back to cited text no. 1
    
2.Thakur P, Revannasiddaiah S, Rastogi M, Kumar S. Requesting clarifications concerning the case report on 'extraskeletal Ewing sarcoma of the sinonasal tract. J Cancer Res Ther 2012;8:652.  Back to cited text no. 2
    
3.Kawabata M, Yoshifuku K, SagaraY, KuronoY. Ewing's sarcoma/primitive neuroectodermal tumour occurring in the maxillary sinus. Rhinology 2008;46:75-8.  Back to cited text no. 3
    
4.Gray ST, Chen YL, Lin DT. Efficacy of Proton Beam Therapy in the Treatment of Ewing's Sarcoma of the Paranasal Sinuses and Anterior Skull Base. Skull Base 2009;19:409-16.  Back to cited text no. 4
    




 

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