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The Laryngoscope Jun 2021The role of locoregional radiotherapy for metastatic oropharyngeal squamous cell cancer (OPSCC) is unclear. We investigated the impact of head and neck radiotherapy on...
OBJECTIVES
The role of locoregional radiotherapy for metastatic oropharyngeal squamous cell cancer (OPSCC) is unclear. We investigated the impact of head and neck radiotherapy on survival in de novo metastatic OPSCC patients who received systemic therapy.
METHODS
We queried the NCDB from 2004-2015 for metastatic OPSCC patients at diagnosis with known HPV-status who received systemic therapy. The association of head and neck radiotherapy with overall survival was analyzed using the Kaplan-Meier method, Cox proportional hazards model, and propensity score-matched analysis adjusting for demographic and disease-specific prognostic factors.
RESULTS
Of the 2,139 patients with metastatic OPSCC who presented with metastases and received systemic treatment, we identified 556 patients with known HPV-status. Among these 556 patients, 49% were HPV-positive and 56% received head and neck radiotherapy. With a median follow-up of 17.5 months (IQR 6.0-163.4 months), radiotherapy was associated with significantly improved 1-year OS (67% vs 58%, log-rank P < .001) which remained significant on MVA (HR 0.78 95% CI 0.62-0.97 P = .029). In HPV-status subgroup analysis, a survival benefit was identified in HPV-positive patients (1-year OS 77% vs 67%, log-rank P < .001) but not in HPV-negative patients. Results were consistent on a propensity score-matched analysis of 212 HPV-positive matched patients (HR 0.66, 95% CI 0.49-0.83, P < .001).
CONCLUSION
The survival of metastatic OPSCC remains limited. In this large series of patients with known HPV-status, head and neck radiotherapy was associated with longer survival in those with HPV-associated disease. These data could guide management of this challenging group of patients for head and neck cancer practitioners.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E1847-E1853, 2021.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis; Propensity Score; Survival Rate
PubMed: 33141455
DOI: 10.1002/lary.29245 -
International Journal of Molecular... Nov 2022Biomarkers are crucial in oncology, from detection and monitoring to guiding management and predicting treatment outcomes. Histological assessment of tissue biopsies is... (Review)
Review
Biomarkers are crucial in oncology, from detection and monitoring to guiding management and predicting treatment outcomes. Histological assessment of tissue biopsies is currently the gold standard for oropharyngeal cancers, but is technically demanding, invasive, and expensive. This systematic review aims to review current markers that are detectable in biofluids, which offer promising non-invasive alternatives in oropharyngeal carcinomas (OPCs). A total of 174 clinical trials from the PubMed search engine in the last 5 years were identified and screened by 4 independent reviewers. From these, 38 eligible clinical trials were found and subsequently reviewed. The biomarkers involved, categorized by human papillomavirus (HPV)-status, were further divided according to molecular and cellular levels. Recent trials investigating biomarkers for both HPV-positive and HPV-negative OPCs have approaches from various levels and different biofluids including plasma, oropharyngeal swabs, and oral rinse. Promising candidates have been found to aid in detection, staging, and predicting prognosis, in addition to well-established factors including HPV-status, drinking and smoking status. These studies also emphasize the possibility of enhancing prediction results and increasing statistical significance by multivariate analyses. Liquid biopsies offer promising assistance in enhancing personalized medicine for cancer treatment, from lowering barriers towards early screening, to facilitating de-escalation of treatment. However, further research is needed, and the combination of liquid biopsies with pre-existing methods, including in vivo imaging and invasive techniques such as neck dissections, could also be explored in future trials.
Topics: Humans; Alphapapillomavirus; Papillomaviridae; Oropharyngeal Neoplasms; Biomarkers; Carcinoma
PubMed: 36430813
DOI: 10.3390/ijms232214336 -
General Dentistry 2021Human papillomavirus (HPV) has a nearly ubiquitous prevalence within the adolescent and adult populations worldwide. The virus has been implicated for decades in...
Human papillomavirus (HPV) has a nearly ubiquitous prevalence within the adolescent and adult populations worldwide. The virus has been implicated for decades in cervical and uterine cancers, but recent data have shown an increase in cases of virally related oropharyngeal squamous cell carcinoma in both male and female cohorts. The objective of this article is to review the oral health implications of HPV infection, including oral and oropharyngeal prevalence, manifestations, neoplastic potential of HPV-associated head and neck lesions, treatment modalities, and vaccine use. The article will also discuss the continuing education needs of oral healthcare providers. Dental professionals should routinely screen patients for oral and oropharyngeal manifestations of HPV infection, seek timely referral for therapeutic intervention of potentially malignant lesions, and become strong proponents of HPV vaccinations for at-risk patients.
Topics: Adolescent; Adult; Alphapapillomavirus; Carcinoma, Squamous Cell; Dentists; Female; Humans; Male; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 33661110
DOI: No ID Found -
Cancer Medicine Apr 2023HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to...
BACKGROUND
HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC.
METHODS
A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regression and Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment.
RESULTS
Black patients had lower overall survival than patients of other races in HPV-positive and HPV-negative OPSCC (HR 1.31, 95% CI 1.13-1.53 and HR 1.23, 95% CI 1.09-1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races.
CONCLUSION
Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non-Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Oropharyngeal Neoplasms; Retrospective Studies; Papillomavirus Infections; Prognosis; Head and Neck Neoplasms; Social Class
PubMed: 36847063
DOI: 10.1002/cam4.5726 -
Auris, Nasus, Larynx Apr 2021Transoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due... (Comparative Study)
Comparative Study
OBJECTIVE
Transoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due to its advantages compared with open surgery. However, knowledge about its benefits compared with transoral laser microsurgery (TLM) are scarce. This study compares oncological and functional results of TLM or TORS in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).
METHODS
This retrospective analysis comprises all patients with OPSCC treated with TLM (n = 30) or TORS (n = 24) between April 2003 and May 2018 (follow-up 43 ± 38.3 months). Both treatment groups (TLM and TORS) were comparable in terms of the stage of the disease, prognosis-determining factors, and adjuvant therapy modalities.
RESULTS
There were no significant differences regarding to the resection status (p = 0.272), the rate of local- (p = 0.834) and distant- recurrence (p = 0.416), with a disease-free survival of 86.7 % and 87.5 %, respectively (p = 0.892). In addition, we could not confirm any differences regarding to operating time (p = 0.860), intraoperative blood loss (p = 0.660), inpatient stay (p = 0.585) and postoperative bleeding rate (p = 0.245). The frequency of tracheostomy and percutaneous endoscopic gastrostomy between both groups is comparable, with a longer duration of tube feeding in patients who have received TLM (p = 0.030).
CONCLUSION
In conclusion, TORS allows for similar oncological outcomes compared with TLM at comparable perioperative risks. The postoperative swallowing function may benefit from TORS.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deglutition; Female; Humans; Laser Therapy; Male; Margins of Excision; Microsurgery; Middle Aged; Natural Orifice Endoscopic Surgery; Oropharyngeal Neoplasms; Radiation Dosage; Retrospective Studies; Robotic Surgical Procedures; Squamous Cell Carcinoma of Head and Neck; Survival Analysis; Treatment Outcome
PubMed: 32883577
DOI: 10.1016/j.anl.2020.08.019 -
Journal of Surgical Oncology Nov 2021Treatment of oropharyngeal cancer (OPC) has undergone considerable evolution since the discovery of human papillomavirus (HPV)-associated OPC. It is widely understood... (Review)
Review
Treatment of oropharyngeal cancer (OPC) has undergone considerable evolution since the discovery of human papillomavirus (HPV)-associated OPC. It is widely understood that HPV OPC affects a younger population and standard treatment offers improved oncologic outcomes compared with non-HPV OPC but can cause significant toxicities and long-term side effects. Surgery for treatment de-escalation is an active area of research. The purpose of this review is to explore surgery as it relates to the treatment of HPV OPC with a focus on the evolution of treatment, rationale for surgery, surgical techniques, outcomes, and the role of surgery in de-escalation of treatment.
Topics: Clinical Trials, Phase II as Topic; Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Randomized Controlled Trials as Topic
PubMed: 34595753
DOI: 10.1002/jso.26695 -
Anticancer Research Nov 2019Oropharyngeal squamous cell carcinoma (OPSCC) could be clinically undetectable despite the relatively large size of lymph node metastases. Here, we aimed to elucidate...
BACKGROUND/AIM
Oropharyngeal squamous cell carcinoma (OPSCC) could be clinically undetectable despite the relatively large size of lymph node metastases. Here, we aimed to elucidate the correlation of p16 expression with epithelial-to-mesenchymal transition (EMT) markers.
PATIENTS AND METHODS
Radically resected 121 OPSCC and 270 non-OPSCC tissue samples were included in the analysis, and p16, Twist, and Snail/Slug immunohistochemistry was performed.
RESULTS
Compared to non-OPSCCs, OPSCCs were significantly associated with lymphovascular invasion, lymph node metastasis, larger maximal diameter of metastatic foci in the lymph nodes, and p16 expression. In addition, p16 expression correlated with high Twist and Snail/Slug expression.
CONCLUSION
Expression of EMT markers, such as Twist and Snail/Slug, is related to p16 expression in OPSCC. This might indicate that HPV infection in OPSCCs alters the expression of EMT markers and results in metastases.
Topics: Biomarkers, Tumor; Carcinoma, Squamous Cell; Cyclin-Dependent Kinase Inhibitor p16; Epithelial-Mesenchymal Transition; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Nuclear Proteins; Oropharyngeal Neoplasms; Papillomavirus Infections; Progression-Free Survival; Snail Family Transcription Factors; Tumor Burden; Twist-Related Protein 1
PubMed: 31704861
DOI: 10.21873/anticanres.13841 -
Head and Neck Pathology Dec 2021Oropharyngeal squamous cell carcinoma (SCC) is increasing in incidence and, in Western countries, strongly associated with transcriptionally-active high-risk human...
Oropharyngeal squamous cell carcinoma (SCC) is increasing in incidence and, in Western countries, strongly associated with transcriptionally-active high-risk human papillomavirus (HPV). Within HPV-positive tumors, there is wide morphologic diversity with numerous histologic subtypes of SCC. There are also variable degrees of keratinization, anaplasia, stromal fibrosis, and maturing squamous differentiation. Unlike in the uterine cervix, where associations between HPV types and lineages/sublineages within types have been investigated with some clear correlations identified, little to no data exists for oropharyngeal SCC. In this study, for a large cohort of oropharyngeal SCC patients, we performed RTPCR for high-risk HPV. For the HPV positive patients, we sequenced the DNA of the entire HPV16 genome and determined lineages and sublineages, correlating HPV status, genotype, and HPV16 lineages/sublineages with SCC subtype and various histologic features. Of the 259 patients, 224 (86.5%) were high-risk HPV positive, of which 210/224 (93.8%) were HPV type 16 and 6/224 (2.7%) HPV type 33. Of the four HPV16 lineages, A was the most frequent (192/214 or 89.8%) and of the HPV16 A sublineages, A1 was the most frequent (112/210 or 53.3%). Patients with HPV negative tumors were more often keratinizing vs other types (23/35 or 65.7%) and thus more likely to have more maturing squamous differentiation and stromal desmoplasia. There was no significant correlation between HPV type (16 versus other), between HPV16 lineage (A versus others), or HPV16 A sublineages (A1 or A2 versus others) and morphologic type of SCC nor the various morphologic features of anaplasia/multinucleation, degree of keratinization, nor amount of stromal desmoplasia. In summary, in our cohort, there was no correlation between the type of HPV, the HPV 16 lineage or sublineage, and any of the histologic features or morphologic SCC subtypes.
Topics: Carcinoma, Squamous Cell; Genome, Viral; Genotype; High-Throughput Nucleotide Sequencing; Human papillomavirus 16; Humans; Oropharyngeal Neoplasms; RNA, Messenger; Reverse Transcriptase Polymerase Chain Reaction
PubMed: 33797697
DOI: 10.1007/s12105-021-01318-4 -
Clinical Cancer Research : An Official... Jan 2022In locally advanced p16+ oropharyngeal squamous cell carcinoma (OPSCC), (i) to investigate kinetics of human papillomavirus (HPV) circulating tumor DNA (ctDNA) and... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
In locally advanced p16+ oropharyngeal squamous cell carcinoma (OPSCC), (i) to investigate kinetics of human papillomavirus (HPV) circulating tumor DNA (ctDNA) and association with tumor progression after chemoradiation, and (ii) to compare the predictive value of ctDNA to imaging biomarkers of MRI and FDG-PET.
EXPERIMENTAL DESIGN
Serial blood samples were collected from patients with AJCC8 stage III OPSCC ( = 34) enrolled on a randomized trial: pretreatment; during chemoradiation at weeks 2, 4, and 7; and posttreatment. All patients also had dynamic-contrast-enhanced and diffusion-weighted MRI, as well as FDG-PET scans pre-chemoradiation and week 2 during chemoradiation. ctDNA values were analyzed for prediction of freedom from progression (FFP), and correlations with aggressive tumor subvolumes with low blood volume (TV) and low apparent diffusion coefficient (TV), and metabolic tumor volume (MTV) using Cox proportional hazards model and Spearman rank correlation.
RESULTS
Low pretreatment ctDNA and an early increase in ctDNA at week 2 compared with baseline were significantly associated with superior FFP ( < 0.02 and < 0.05, respectively). At week 4 or 7, neither ctDNA counts nor clearance were significantly predictive of progression ( = 0.8). Pretreatment ctDNA values were significantly correlated with nodal TV, TV, and MTV pre-chemoradiation ( < 0.03), while the ctDNA values at week 2 were correlated with these imaging metrics in primary tumor. Multivariate analysis showed that ctDNA and the imaging metrics performed comparably to predict FFP.
CONCLUSIONS
Early ctDNA kinetics during definitive chemoradiation may predict therapy response in stage III OPSCC.
Topics: Alphapapillomavirus; Biomarkers; Carcinoma, Squamous Cell; Circulating Tumor DNA; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Kinetics; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 34702772
DOI: 10.1158/1078-0432.CCR-21-2338 -
Dermatologic Clinics Oct 2020The Surveillance, Epidemiology, and End Results program from the National Cancer Institute reports that the aggregate number of oral cavity and pharyngeal cancer cases... (Review)
Review
The Surveillance, Epidemiology, and End Results program from the National Cancer Institute reports that the aggregate number of oral cavity and pharyngeal cancer cases has been increasing over the past decade and, despite an overall decline in oral cavity cancers, this increase is largely related to a dramatic increase in cancers involving oropharyngeal subsites. Early detection of oral cavity cancers is commensurate with improved survival, and opportunistic screening by trained clinicians to detect oral cavity cancer and oral potentially malignant disorders is recommended by the American Dental Association and the American Academy of Oral Medicine.
Topics: Early Detection of Cancer; Humans; Mouth Neoplasms; Neoplasm Staging; Oropharyngeal Neoplasms; Precancerous Conditions; Squamous Cell Carcinoma of Head and Neck
PubMed: 32892859
DOI: 10.1016/j.det.2020.05.011