Page 161 - New epidemiological and PSMA-expression based paradigms in salivary gland tumors
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glands, since these have been earlier described by anatomists. Our manuscript however mentioned earlier descriptions in papers and indirectly their references (dating back to 1874) of a higher density of glands in this area. The novelty concerned the visualization and interpretation of the gland conglomerate as comparable to the major salivary glands with new techniques. And because of this new interpretation, possible clinical implications as “a potential new organ at risk” could be evaluated in a large clinical study. The words ‘‘new” and ‘‘organ” in the title seem to have been a trigger for massive media attention. This might have caused some distraction from the core message of the manuscript.
The core of our message is the fact that the gland tissue in this area has not been considered as an organ at risk (OAR) in radiotherapy. One should realize that an OAR does not only concern organs, but it comprises all tissues near the clinical target volume that can get damaged by radiation. The new techniques of PSMA PET/CT and 3D reconstruction of histological slides that were presented in the paper, opened a new perspective that did not fit previous anatomical descriptions. Another comment was that it is too early to call this gland a salivary gland, because of uncertainties regarding the fluid composition, and the location of the gland in the nasopharynx. These issues are addressed by discussing the definition of saliva and comparing the characteristics of tubarial glands to those one of the major salivary glands, the sublingual gland. Also, relevant results of additional research are presented, that suggest presence of tubarial gland fluid in the oral cavity. Also, some anatomists have questioned the evidence for presence of tubarial salivary glands, but seem to have missed the nuanced discussion in our paper regarding the positioning of our findings.
An important issue that should have had more emphasis in our paper was the gender imbalance in the patients whose data were used for defining the position of the tubarial glands.
Finally, consequences of the realization that a major glandular structure is present in the nasopharynx, for other diseases are discussed. We conclude that the tubarial gland paper is only a starting point and new questions will need additional interesting research.
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