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Other Comments:
Nair et al have reported a uncommon case of a HPC with delayed extraneural metastasis. There was a good response to radiation therapy. The differential diagnosis in this case is varied and it is mandatory to make a correct diagnosis to deliver appropriate treatment which would have a impact on the ultimate outcome. Routine IHC and electron microscopy cn be helpful but molecular studies are becoming more refined and can sometimes clinch the diagnosis, as in this case.
In addition, the unpredictable course of natural history also makes it difficult to prognostiate since some HPC's have a tendency for local recurrence and a fatal outcome while some are well inspite of a delayed extraneural metastasis as in this case. This clearly shows that we are still in infancy in the comprehension of a cancer cell.
The use of helical tomography in this case is also novel and helps deliver RT in safer manner.
The longterm outcome of the patient needs to be seen in this case.
The manuscript is well written and referenced.
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Competing interests:
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Invited by the author to review this article? :
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Have you previously published on this or a similar topic?:
No
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References:
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Experience and credentials in the specific area of science:
Surgery for brain tumors
- How to cite: Muzumdar D .Meningeal Hemangiopericytoma With Delayed Extra-neuraxial Metastases: Diagnostic Conundrum And Management Using High-precision Simultaneous Multi-target Irradiation On Helical Tomotherapy [Review of the article 'Meningeal Hemangiopericytoma With Delayed Extra-neuraxial Metastases: Diagnostic Conundrum And Management Using High-precision Simultaneous Multi-target Irradiation On Helical Tomotherapy ' by Rekhi B].WebmedCentral 2010;1(12):WMCRW00255
- Other Comments: Well written case report describing treatment response of a rare tumor type. 1) A report of the longer f/u progression free interval would be important to add. 2) It would be of interest to show the original pathology and contrast to the new metastatic focus.
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Invited by the author to review this article? :
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Have you previously published on this or a similar topic?:
No
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References:
None -
Experience and credentials in the specific area of science:
None - How to cite: Kesari S .Response of HPC to radiation[Review of the article 'Meningeal Hemangiopericytoma With Delayed Extra-neuraxial Metastases: Diagnostic Conundrum And Management Using High-precision Simultaneous Multi-target Irradiation On Helical Tomotherapy ' by Rekhi B].WebmedCentral 2010;1(11):WMCRW00114
This is a well written and referenced manuscript.
There were several sites of metastasis visualised on FDG-PET/CT, however it seems only two were symptomatic - the jaw and the chest wall. The primary and realistic goal of radiotherapy (RT) was pain relief and RT to these two sites with similar fractionation and simpler methods and more readily available equipment (telecobalt or 6-MV linear accelerator based treatment) would have very likely yielded similar pain relief. Growth restraining measures with RT to other asymptomatic sites, in the presence of extensive dissemination is unlikely to impact on survival, and so the use of tomotherapy, while technically superior and sparing normal tissues, is perhaps not necessary, not withstanding the good performance status of this patient.
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As a radiation oncologist treating both CNS sites and administering RT for palliation