How would you modify adjuvant radiation for oral cavity SCC based on the presence of sarcomatoid features?

Suggest to discuss the sarcomatoid features with the pathologist. There are two possibilities:

1. Spindle cell carcinoma is a variant of squamous cell carcinoma characterized by spindled or pleomorphic cells that appear to be sarcoma but are actually epithelial. Some of these can be HPV-related and have a good prognosis. On the other hand, 2. Carcinosarcoma is a rare variant of sqcca with components of PD squamous cells and mesenchymal cells with spindle cell proliferation. This is more common in the oral cavity. The largest series I have found is from Chang et al., PMID 24284734, where 78 pts with this histology were identified out of about 13,000 HNC pts. In this series, the 5-year survival rate was 16%. Other smaller series also suggest t...

I treat as I would a poorly differentiated SCC.