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Current Treatment Options in Oncology Dec 2014Human papillomavirus-associated oropharynx cancer (HPV-OPC) is growing in incidence and has distinct clinical, pathologic, molecular, and epidemiologic features.... (Review)
Review
Human papillomavirus-associated oropharynx cancer (HPV-OPC) is growing in incidence and has distinct clinical, pathologic, molecular, and epidemiologic features. However, the management of HPV-OPC does not presently differ from HPV-negative OPC based on the current evidence and requires complex multidisciplinary approaches. The superior prognosis of HPV-OPC and the toxicities of current multimodality treatment in a young population serve as the impetus to evaluate de-intensification treatment regimens aimed at reducing toxicity while maintaining therapeutic efficacy. Clinical trials are underway to evaluate reduced doses of radiation or less toxic systemic therapy regimens in HPV-OPC. Minimally invasive surgical approaches in the HPV-OPC population with early tumor stage also are being investigated. De-intensification strategies should only be employed in the context of clinical trials, and HPV-OPC patients should be offered clinical trials' participation. Appropriate patient selection is critical to the development of de-intensification regimens, and this requires greater understanding of risk factors within the HPV-OPC population, HPV-OPC biology, and how HPV modulates response to specific therapies. Smoking history and bulky nodal disease have been shown to impact negatively the favorable prognosis of HPV association. Validated biomarkers within the HPV-OPC population are lacking, although alterations in the PI3K pathway and markers of immune response may emerge as important considerations in the future. Novel therapeutic strategies are desperately needed particularly for HPV-OPC patients who fail definitive therapy, and select patients with recurrent or metastatic disease may benefit from aggressive approaches.
Topics: Carcinoma, Squamous Cell; Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Treatment Outcome
PubMed: 25240410
DOI: 10.1007/s11864-014-0309-1 -
Anticancer Research Mar 2018Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the...
BACKGROUND/AIM
Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the method of recurrence detection in HPV+ disease to determine a role for follow-up imaging.
PATIENTS AND METHODS
All HPV+ and HPV- oropharyngeal cancer patients treated at our institution from 2005-2016 with biopsy-proven recurrence were identified and their method of recurrence detection was analyzed.
RESULTS
A total of 16 HPV+ oropharyngeal cancer patients were identified to have recurrence, 12 (75%) of which experienced distant recurrence and 13 (81.3%) were detected asymptomatically with imaging at a median time of 19.7 months after initial treatment and verifying no residual disease. Twelve (75%) detections were with PET-CT. While HPV- patients (17 patients) also have a high rate of asymptomatic detection (16 patients, 94.1%), their 3-year post-recurrence survival was significantly lower at 6.5% compared to 83.6% for the HPV+ group (p<0.01).
CONCLUSION
In HPV+ patients, a large proportion of failures are asymptomatic distant metastases, which occur beyond 6 months following treatment completion, and are detected with whole body imaging alone. In light of long term post-recurrence survival observed, this preliminary data suggests that routine surveillance imaging should be further studied for HPV+ disease.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Positron Emission Tomography Computed Tomography; Retrospective Studies; Salvage Therapy; Treatment Outcome
PubMed: 29491081
DOI: 10.21873/anticanres.12380 -
Salud Publica de Mexico Apr 2016Oropharyngeal cancer incidence has recently increased, thereby attracting public attention. Akin to other malignancies of the upper aerodigestive tract, it has been... (Review)
Review
Oropharyngeal cancer incidence has recently increased, thereby attracting public attention. Akin to other malignancies of the upper aerodigestive tract, it has been attributed to the carcinogenic effects of tobacco and alcohol use. However, recent evidence shows that a substantial increase in the disease is attributable to the effects of human papillomavirus (HPV). Marked progress has been made in relation to the knowledge of molecular and genetic mechanisms involved in the genesis and progression of these cancers. This has led to the development of new and promising therapies of a more specific and less toxic nature that have prolonged life and improved its quality. However, these therapies have failed to significantly increase the proportion of patients who are cured. To decrease the mortality associated with these neoplasms, it is necessary to adopt public health measures aimed at prevention and early diagnosis.
Topics: Combined Modality Therapy; Disease Management; Humans; Incidence; Mexico; Morbidity; Neoplasm Metastasis; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Quality of Life; Risk Factors
PubMed: 27557387
DOI: 10.21149/spm.v58i2.7798 -
Oral Oncology Dec 2023Transoral robotic surgery (TORS) is increasingly employed in the management of oropharyngeal cancer without adjuvant treatment. Attaining safe surgical margins is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transoral robotic surgery (TORS) is increasingly employed in the management of oropharyngeal cancer without adjuvant treatment. Attaining safe surgical margins is paramount to preventing local recurrence (LR), but the necessary surgical margin dimension remains contentious.
METHODS
Systematic review and meta-analysis of studies reporting margin status and LR following TORS without adjuvant therapy for primary OPSCC.
RESULTS
The search identified 269 articles and 11 were selected for inclusion, with 406 patients included in the meta-analysis. Heterogeneity was noted in the definition of "close" margins. Random-effects pooled rate of positive margins was 7 % (95 % CI 0.04-0.12, I = 54 %, p = 0.02) and close margins was 7 % (95 % CI 0.02-0.27, I = 86 %, p=<0.01). The random-effects overall rate of LR was 6 % (95 % CI 0.04-0.10, I = 11 %, p = 0.35), 13 % (95 % CI 0.02-0.620, I = 0 %, p = 1.0) after a positive margin, and 3 % (95 % CI 0.03-0.24, I = 23 %, p = 0.26) after a close margin. Odds ratio (OR) for LR indicated higher risk of LR for positive compared to close margins (7.5; 95 % CI 1.31-42.91, I = 0 %, p = 0.51), and a slightly lower risk of LR between close and negative margins (2.22; 95 % CI 0.67-7.38, I = 0 %, p = 0.8). A lack of frozen-section analysis (OR 2.91, p = 0.36) and HPV-negative disease (OR 1.68, p = 0.03) were associated with an elevated risk of LR.
CONCLUSIONS
TORS as a standalone treatment is associated with low rates of LR; however, the literature is hampered by considerable heterogeneity in margin definitions. Larger multicentre studies are required to determine the precise margin cut-off required for oropharyngeal tumours managed with TORS alone.
Topics: Humans; Margins of Excision; Robotic Surgical Procedures; Combined Modality Therapy; Oropharyngeal Neoplasms; Odds Ratio; Retrospective Studies; Neoplasm Recurrence, Local
PubMed: 37951118
DOI: 10.1016/j.oraloncology.2023.106610 -
Brazilian Journal of Otorhinolaryngology 2022To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to...
OBJECTIVE
To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to estimate the influence of clinical stage and treatment type on overall and disease-free survival.
METHODS
We retrospectively analyzed epidemiological data from the São Paulo Cancer Center Foundation database relative to patients with oropharyngeal squamous cell carcinoma diagnosed between 2004 and 2014 in the state of São Paulo. Univariate and multivariate Cox regression analyses were performed to assess factors associated with the outcomes. A forward stepwise selection procedure was used. Survival curves were estimated by the Kaplan-Meier method and compared by the Gehan-Breslow-Wilcoxon test.
RESULTS
A total of 8075 individuals with oropharyngeal squamous cell carcinoma were identified. Of these, 86.3% were diagnosed at an advanced stage and 13.7% at an early stage. Only 27.2% of patients were treated surgically, whereas 57.5% were treated medically. Patients undergoing surgery had longer overall survival than those receiving medical treatment in both early- and advanced-stage oropharyngeal squamous cell carcinoma. However, there was no significant difference in disease-free survival between surgical and medical treatment.
CONCLUSION
No significant difference in disease-free survival between medical and surgical treatment suggests similar complete remission rates with both approaches. Patients receiving medical treatment had shorter overall survival, which may be due to complications from chemotherapy and radiotherapy. However, we cannot confirm this relationship based on the data provided by the São Paulo Cancer Center Foundation. Prospective studies are warranted to assess whether the lower overall survival rate in patients receiving medical treatment is secondary to complications from chemotherapy and radiotherapy.
LEVEL OF EVIDENCE
2C.
Topics: Humans; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Prognosis; Carcinoma, Squamous Cell; Retrospective Studies; Brazil; Head and Neck Neoplasms; Neoplasm Staging
PubMed: 36064816
DOI: 10.1016/j.bjorl.2022.07.003 -
Radiographics : a Review Publication of... 2019During the past decade and a half, the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) has shifted from tobacco and alcohol to the human... (Review)
Review
During the past decade and a half, the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) has shifted from tobacco and alcohol to the human papillomavirus (HPV). HPV-driven p16-positive OPSCC and tobacco-related OPSCC differ in their underlying molecular and genetic profiles, socioeconomic demographics, and response to treatment. HPV-related OPSCC tends to occur in younger patients and has a significantly better response to treatment and excellent prognosis. The stark contrast in prognosis-with around 90% overall 5-year survival for HPV-related p16-positive OPSCC and 40% for non-HPV-related p16-negative OPSCC-has prompted major changes in the eighth edition of the staging manual of the AJCC (American Joint Committee on Cancer). The past 10-15 years have also witnessed major advances in surgery, radiation therapy (RT), and systemic therapy. Minimally invasive surgery has come of age, with transoral robotic procedures and laser microsurgery. Intensity-modulated RT (IMRT) and more recently proton-beam RT have markedly improved the conformity of RT, with an ability to precisely target the cancer and cancer-bearing regions while sparing normal structures and significantly reducing long-term treatment-related morbidity. Progress in systemic therapy has come in the form of immunotherapy and targeted agents such as cetuximab. Owing to the better prognosis of HPV-driven OPSCC as well as the morbidity associated with treatment, de-escalation of therapy via multiple strategies is being explored. The article reviews the advances in diagnosis and multidisciplinary management of OPSCC in the HPV era.RSNA, 2019.
Topics: Age Distribution; Alcohol Drinking; Carcinoma, Squamous Cell; Cell Cycle; Chemotherapy, Adjuvant; Clinical Trials as Topic; Combined Modality Therapy; Diagnostic Imaging; Disease Management; Human papillomavirus 16; Humans; Immunotherapy; Lymphatic Metastasis; Neoplasm Staging; Oncogene Proteins, Viral; Oral Surgical Procedures; Oropharyngeal Neoplasms; Papillomavirus E7 Proteins; Papillomavirus Infections; Prognosis; Radiotherapy, Adjuvant; Repressor Proteins; Risk Factors; Salvage Therapy; Smoking
PubMed: 31603733
DOI: 10.1148/rg.2019190007 -
The Laryngoscope Jul 2019Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to... (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to compare financial parameters between chemoradiation and transoral robotic surgery (TORS) in this patient population.
STUDY DESIGN
Case-control study.
METHODS
In this study we identified patients with selected American Joint Committee on Cancer 7th Edition stage II to IVa OPC treated with TORS between January 2013 and December 2014. Fifteen patients who underwent TORS were stage matched with 15 patients treated with chemoradiation. Total charges and cost data for each patient were analyzed at 4-month and 1-year time points; functional and oncologic outcomes were assessed.
RESULTS
There were no significant differences in functional and oncologic outcomes. Patients undergoing TORS had a longer inpatient hospital stay, and most required a nasogastric tube for an average of 3.5 days. There were no local or regional recurrences. Across all time points, the TORS group had lower charges and costs compared to the chemoradiation group, with 14% lower costs at 1 year. In the chemoradiation group, nearly two-thirds of costs came from radiation therapy and pharmacy expenses. Chemotherapy accounted for most pharmacy costs. The costs of operating the surgical robot accounted for a about half of surgical costs.
CONCLUSIONS
Selected patients with stage II to IVa oropharyngeal carcinoma treated with TORS may incur lower costs than those treated nonsurgically. With rising healthcare spending, the financial impact of treatment might be considered for those patients eligible for treatment regimens with comparable functional and oncologic outcomes.
LEVEL OF EVIDENCE
3b Laryngoscope, 129:1604-1609, 2019.
Topics: Case-Control Studies; Chemoradiotherapy; Costs and Cost Analysis; Female; Humans; Intubation, Gastrointestinal; Length of Stay; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Robotic Surgical Procedures
PubMed: 30485445
DOI: 10.1002/lary.27544 -
Head and Neck Pathology Dec 2021Primary mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN) of the head and neck region is a rare biphasic tumor with an aggressive biological behavior. This report... (Review)
Review
Primary mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN) of the head and neck region is a rare biphasic tumor with an aggressive biological behavior. This report highlights an additional case of oropharyngeal MiNEN in a 46-year-old male patient with a previous long-term smoking history. Histologic evaluation revealed a biphasic tumor infiltrating the lamina propria. The first component consisted of a classic keratinizing squamous cell carcinoma. The second component consisted of small-to-intermediate sized cells with neuroendocrine features. Synaptophysin and CD56 immunohistochemical stains confirmed neuroendocrine lineage in this component. The presence of two morphological components with neuroendocrine and nonneuroendocrine features on histologic assessment should alert the pathologist to consider a MiNEN in their case work-up.
Topics: Biomarkers, Tumor; Diagnosis, Differential; Humans; Male; Middle Aged; Neoplasms, Complex and Mixed; Neuroendocrine Tumors; Oropharyngeal Neoplasms; Smokers; Tomography, X-Ray Computed
PubMed: 33709305
DOI: 10.1007/s12105-021-01312-w -
Head & Neck Sep 2016There are no level I studies to guide treatment for resectable oropharyngeal squamous cell carcinoma (SCC). Treatment toxicities influence management recommendations.... (Review)
Review
BACKGROUND
There are no level I studies to guide treatment for resectable oropharyngeal squamous cell carcinoma (SCC). Treatment toxicities influence management recommendations. Ongoing investigations are examining deintensified treatments for human papillomavirus (HPV)-associated oropharyngeal SCC.
METHODS
The Appropriateness Criteria panel, using modified Delphi methodology, produced a literature summary, an assessment of treatment recommendations, and cases to illustrate their use.
RESULTS
A multidisciplinary team produces optimum results. Based on HPV status, smoking history, and staging, patients are divided into groups at low, intermediate, and high-risk of death. In the future, treatment recommendations may be influenced by HPV status, which has changed the epidemiology of oropharyngeal SCC.
CONCLUSION
T1 to T2N0M0 resectable oropharyngeal SCC can be treated with surgery or radiation without chemotherapy. Patients with T1-2N1-2aM0 disease can receive radiation, chemoradiation, or transoral surgery with neck dissection and appropriate adjuvant therapy. Patients with T1-2N2b-3M0 disease should receive chemoradiation or transoral surgery with neck dissection and appropriate adjuvant therapy. Concurrent chemoradiation is preferred for T3 to T4 disease. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1299-1309, 2016.
Topics: Aged; Carcinoma, Squamous Cell; Chemoradiotherapy; Combined Modality Therapy; Delphi Technique; Disease-Free Survival; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck Dissection; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Oropharynx; Papillomavirus Infections; Pharyngectomy; Practice Guidelines as Topic; Prognosis; Risk Assessment; Societies, Medical; Squamous Cell Carcinoma of Head and Neck; Survival Analysis
PubMed: 27330003
DOI: 10.1002/hed.24447 -
Head & Neck Apr 2019We investigated the survival of patients with a p16-positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and...
BACKGROUND
We investigated the survival of patients with a p16-positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and treatment characteristics.
METHODS
We retrospectively reviewed the data of patients treated at our Cancer Center for a p16-positive N3 OPSCC between 2003 and 2016. End points were overall survival (OS) and progression-free survival (PFS).
RESULTS
A total of 29 patients were included. The 5-year OS and PFS were 67.5% and 59.1%, respectively. Smoking history above 10 pack-years and the absence of human papillomavirus DNA were associated with worse OS (P = .02 and P = .03, respectively) and PFS (P = .02 and P = .02, respectively). Induction chemotherapy or radical neck dissection were not associated with different treatment outcomes.
CONCLUSION
Patients with an N3 p16-positive oropharyngeal cancer in our series had a 5-year OS rate of 67.5%. Smoking history and viral DNA were prognostic factors associated with survival.
Topics: Cohort Studies; DNA, Viral; Databases, Factual; Disease-Free Survival; Female; Genes, p16; Head and Neck Neoplasms; Humans; Kaplan-Meier Estimate; Male; Neoplasm Invasiveness; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Smoking; Squamous Cell Carcinoma of Head and Neck; Survival Analysis
PubMed: 30552841
DOI: 10.1002/hed.25523