Response

Extract

We welcome Dr. Harari's refreshing embrace of a novel strategy for the resolution of a long-standing oncologic impasse. Comparative microsatellite analysis is a highly effective tool in distinguishing second lung tumors from lung metastasis. No doubt, similar genetic strategies addressing equally relevant clinical issues will play an increasing role in the integrated multidisciplinary approach to patients with head and neck squamous cell carcinoma (HNSCC) and cancers at other sites.

As always, caution and discretion must be exercised when generalizing study results to the individual patient. Our study reflects the experience of a large tertiary care center where patients are often referred for management of advanced HNSCC. As Dr. Harari points out, the incidence of solitary lung metastases will probably be lower in patient populations over represented by low-stage HNSCCs. For the individual patient with HNSCC, however, microsatellite analysis remains a valid and valuable tool for discerning the nature of a solitary lung tumor. The use of such molecular approaches is not intended to replace sound clinical judgment but to facilitate it.