-
Clinical & Translational Oncology :... May 2021Head and neck cancers (HNC) are defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than...
Head and neck cancers (HNC) are defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2017 publication, the Spanish Society of Medical Oncology (SEOM) presents an update of the squamous cell HNC diagnosis and treatment guideline. Most relevant diagnostic and therapeutic changes from the last guideline have been updated: introduction of sentinel node biopsy in early oral/oropharyngeal cancer treated with surgery, concomitant radiotherapy with weekly cisplatin 40 mg/m in the adjuvant setting, new approaches for HPV-related oropharyngeal cancer and new treatments with immune-checkpoint inhibitors in recurrent/metastatic disease.
Topics: Alphapapillomavirus; Chemoradiotherapy, Adjuvant; Cisplatin; Head and Neck Neoplasms; Humans; Immune Checkpoint Inhibitors; Medical Oncology; Mouth Neoplasms; Neoplasm Staging; Organ Sparing Treatments; Oropharyngeal Neoplasms; Radiation-Sensitizing Agents; Radiotherapy, Adjuvant; Sentinel Lymph Node Biopsy; Societies, Medical; Spain; Squamous Cell Carcinoma of Head and Neck
PubMed: 33635468
DOI: 10.1007/s12094-020-02533-1 -
The Cochrane Database of Systematic... Dec 2021Oral cavity and oropharyngeal cancers are the most common cancers arising in the head and neck. Treatment of oral cavity cancer is generally surgery followed by... (Review)
Review
BACKGROUND
Oral cavity and oropharyngeal cancers are the most common cancers arising in the head and neck. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients. This review updates one last published in 2011.
OBJECTIVES
To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal squamous cell carcinoma results in improved overall survival, improved disease-free survival and/or improved locoregional control, when incorporated as either induction therapy given prior to locoregional treatment (i.e. radiotherapy or surgery), concurrent with radiotherapy or in the adjuvant (i.e. after locoregional treatment with radiotherapy or surgery) setting.
SEARCH METHODS
An information specialist searched 4 bibliographic databases up to 15 September 2021 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and that evaluated the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration.
DATA COLLECTION AND ANALYSIS
For this update, we assessed the new included trials for their risk of bias and at least two authors extracted data from them. Our primary outcome was overall survival (time to death from any cause). Secondary outcomes were disease-free survival (time to disease recurrence or death from any cause) and locoregional control (response to primary treatment). We contacted trial authors for additional information or clarification when necessary.
MAIN RESULTS
We included 100 studies with 18,813 participants. None of the included trials were at low risk of bias. For induction chemotherapy, we reported the results for contemporary regimens that will be of interest to clinicians and people being treated for oral cavity and oropharyngeal cancers. Overall, there is insufficient evidence to clearly demonstrate a survival benefit from induction chemotherapy with platinum plus 5-fluorouracil prior to radiotherapy (hazard ratio (HR) for death 0.85, 95% confidence interval (CI) 0.70 to 1.04, P = 0.11; 7427 participants, 5 studies; moderate-certainty evidence), prior to surgery (HR for death 1.06, 95% CI 0.71 to 1.60, P = 0.77; 198 participants, 1 study; low-certainty evidence) or prior to concurrent chemoradiation (CRT) with cisplatin (HR for death 0.71, 95% CI 0.37 to 1.35, P = 0.30; 389 participants, 2 studies; low-certainty evidence). There is insufficient evidence to support the use of an induction chemotherapy regimen with cisplatin plus 5-fluorouracil plus docetaxel prior to CRT with cisplatin (HR for death 1.08, 95% CI 0.80 to 1.44, P = 0.63; 760 participants, 3 studies; low-certainty evidence). There is insufficient evidence to support the use of adjuvant chemotherapy over observation only following surgery (HR for death 0.95, 95% CI 0.73 to 1.22, P = 0.67; 353 participants, 5 studies; moderate-certainty evidence). Among studies that compared post-surgical adjuvant CRT, as compared to post-surgical RT, adjuvant CRT showed a survival benefit (HR 0.84, 95% CI 0.72 to 0.98, P = 0.03; 1097 participants, 4 studies; moderate-certainty evidence). Primary treatment with CRT, as compared to radiotherapy alone, was associated with a reduction in the risk of death (HR for death 0.74, 95% CI 0.67 to 0.83, P < 0.00001; 2852 participants, 24 studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS: The results of this review demonstrate that chemotherapy in the curative-intent treatment of oral cavity and oropharyngeal cancers only seems to be of benefit when used in specific circumstances together with locoregional treatment. The evidence does not show a clear survival benefit from the use of induction chemotherapy prior to radiotherapy, surgery or CRT. Adjuvant CRT reduces the risk of death by 16%, as compared to radiotherapy alone. Concurrent chemoradiation as compared to radiation alone is associated with a greater than 20% improvement in overall survival; however, additional research is required to inform how the specific chemotherapy regimen may influence this benefit.
Topics: Chemoradiotherapy, Adjuvant; Humans; Mouth Neoplasms; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms
PubMed: 34929047
DOI: 10.1002/14651858.CD006386.pub4 -
Journal of Clinical Oncology : Official... Apr 2020Plasma circulating tumor human papillomavirus DNA (ctHPVDNA) is a sensitive and specific biomarker of human papillomavirus (HPV)-associated oropharyngeal squamous cell...
PURPOSE
Plasma circulating tumor human papillomavirus DNA (ctHPVDNA) is a sensitive and specific biomarker of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). We investigated whether longitudinal monitoring of ctHPVDNA during post-treatment surveillance could accurately detect clinical disease recurrence.
METHODS AND MATERIALS
A prospective biomarker clinical trial was conducted among patients with nonmetastatic HPV-associated (p16-positive) OPSCC. All patients were treated with curative-intent chemoradiotherapy (CRT). Patients underwent a 3-month post-CRT positron emission tomography/computed tomography scan and were thereafter clinically evaluated every 2-4 months (years 1-2), then every 6 months (years 3-5). Chest imaging was performed every 6 months. Blood specimens were collected every 6-9 months for analysis of plasma ctHPVDNA using a multianalyte digital polymerase chain reaction assay. The primary endpoint was to estimate the negative predictive value (NPV) and positive predictive value (PPV) of ctHPVDNA surveillance.
RESULTS
One hundred fifteen patients were enrolled, and 1,006 blood samples were analyzed. After a median follow-up time of 23 months (range, 6.1-54.7 months), 15 patients (13%) developed disease recurrence. Eighty-seven patients had undetectable ctHPVDNA at all post-treatment time points, and none developed recurrence (NPV, 100%; 95% CI, 96% to 100%). Twenty-eight patients developed a positive ctHPVDNA during post-treatment surveillance, 15 of whom were diagnosed with biopsy-proven recurrence. Sixteen patients had 2 consecutively positive ctHPVDNA blood tests, 15 of whom developed biopsy-proven recurrence. Two consecutively positive ctHPVDNA blood tests had a PPV of 94% (95% CI, 70% to 99%). Median lead time between ctHPVDNA positivity and biopsy-proven recurrence was 3.9 months (range, 0.37-12.9 months).
CONCLUSION
Detection of ctHPVDNA in two consecutive plasma samples during post-treatment surveillance has high PPV and NPV for identifying disease recurrence in patients with HPV-associated oropharyngeal cancer and may facilitate earlier initiation of salvage therapy.
Topics: Adult; Aged; Aged, 80 and over; Alphapapillomavirus; Biomarkers, Tumor; Circulating Tumor DNA; Clinical Trials, Phase II as Topic; DNA, Viral; Female; Humans; Longitudinal Studies; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomavirus Infections; Prospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 32017652
DOI: 10.1200/JCO.19.02444 -
Praxis Jul 2020
Topics: Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 32635853
DOI: 10.1024/1661-8157/a003483 -
Current Treatment Options in Oncology Mar 2023Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) incidence has been increasing in recent decades. Treatment of the locally advanced... (Review)
Review
Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) incidence has been increasing in recent decades. Treatment of the locally advanced HPV-related OPSCC includes a multidisciplinary approach. Immunotherapy with immune checkpoint inhibitors is used in the treatment of patients with recurrent/metastatic head and neck squamous cell carcinomas (HNSCC), including HPV-related OPSCC patients. There is increasing knowledge of the role of HPV in the tumor immune microenvironment. Therefore, HPV status of OPSCC plays an essential role in the design of immunotherapy clinical trials in both curative intent and metastatic settings. Moreover, HPV has become a potential therapeutic target, with vaccines and adoptive T-cell therapies being developed against HPV for the treatment of OPSCC. Several novel studies are designed to target HPV in combination with immune checkpoint inhibitors. Thus, HPV-related OPSCC remains a unique subgroup in the immunotherapy era.
Topics: Humans; Human Papillomavirus Viruses; Carcinoma, Squamous Cell; Papillomavirus Infections; Immune Checkpoint Inhibitors; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Head and Neck Neoplasms; Squamous Cell Carcinoma of Head and Neck; Immunotherapy; Tumor Microenvironment
PubMed: 36719604
DOI: 10.1007/s11864-023-01050-x -
Journal of Clinical Oncology : Official... Jun 2023
Topics: Humans; Human Papillomavirus Viruses; Incidence; Oropharyngeal Neoplasms; Carcinoma, Squamous Cell; Papillomavirus Infections
PubMed: 37285652
DOI: 10.1200/JCO.23.00224 -
Laryngo- Rhino- Otologie Jun 2024
Topics: Humans; Oropharyngeal Neoplasms; Robotic Surgical Procedures; Combined Modality Therapy
PubMed: 38830354
DOI: 10.1055/a-2216-7575 -
Cancer Radiotherapie : Journal de La... 2022This article reviews the various treatment options, by primary or postoperative external radiotherapy and by brachytherapy for the p16-negative oropharyngeal squamous... (Review)
Review
This article reviews the various treatment options, by primary or postoperative external radiotherapy and by brachytherapy for the p16-negative oropharyngeal squamous cell carcinoma. Dose levels, fractionation and association with systemic treatments are presented. The need for neck node dissection post local treatment is discussed, as well as specificities for the management of p16-positive tumours. Guidelines for target volume selection and delineation are thoroughly elaborated. Last, the management by radiotherapy of locoregional recurrences is discussed.
Topics: Brachytherapy; Cyclin-Dependent Kinase Inhibitor p16; Dose Fractionation, Radiation; France; Humans; Induction Chemotherapy; Neck Dissection; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Radiation Oncology; Retreatment; Societies, Medical; Squamous Cell Carcinoma of Head and Neck
PubMed: 34953693
DOI: 10.1016/j.canrad.2021.10.002 -
Magnetic Resonance Imaging Clinics of... Feb 2022MR imaging is the modality of choice in the evaluation of oral cavity and oropharyngeal cancer. Routine postcontrast MR imaging is important for the accurate... (Review)
Review
MR imaging is the modality of choice in the evaluation of oral cavity and oropharyngeal cancer. Routine postcontrast MR imaging is important for the accurate localization and characterization of the locoregional extension of oral cavity and oropharyngeal cancers. The anatomy of the oral cavity and oropharynx is complex; accurate interpretation is vital for description of the extension of the masses. Understanding the new changes in the eighth edition of the American Joint Committee on Cancer staging system. MR imaging is the imaging modality of choice for detection of perineural spread.
Topics: Humans; Magnetic Resonance Imaging; Mouth; Neoplasm Staging; Oropharyngeal Neoplasms
PubMed: 34802580
DOI: 10.1016/j.mric.2021.07.002 -
Clinical Oral Investigations Dec 2023To conduct a systematic review to determine the global prevalence of HPV in oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To conduct a systematic review to determine the global prevalence of HPV in oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC).
MATERIALS AND METHODS
Literature was searched through October 2022 in main databases to address the question "What is the global prevalence of Human Papillomavirus in oral and oropharyngeal cancer?" Studies had to identify HPV by PCR, ISH, or p16 immunohistochemistry to be eligible. Quality was assessed using the JBI checklist for prevalence studies. Meta-analyses were performed, and reporting followed PRISMA guidelines.
RESULTS
Sixty-five studies were included, and most of them had methodological limitations related to sampling and the HPV detection tool. The pooled prevalence of HPV-positivity was 10% (event rate = 0.1; 95% CI: 0.07, 0.13; P < 0.01; I = 88%) in the oral cavity and 42% (event rate = 0.42; 95% CI: 0.36, 0.49; P = 0.02; I2 = 97%) in oropharynx. The highest HPV prevalence in OSCC was reached by Japan, meanwhile, in OPSCC, Finland and Sweden were the most prevalent. HPV16 is the genotype most frequent with 69% in OSCC and 89% in OPSCC, being the tonsils the intraoral location more affected by HPV (63%, p < 0.01, I 76%).
CONCLUSION
The evidence points to an apparent burden in HPV-related OPSCC, mostly in North America, Northern Europe, and Oceania, especially due to the HPV16 infection suggesting different trends across continents.
CLINICAL RELEVANCE
This updated systematic review and meta-analysis provide sufficient evidence about the global HPV prevalence in OSCC and OPSCC and the most frequent HPV subtype worldwide.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Carcinoma, Squamous Cell; Human Papillomavirus Viruses; Papillomavirus Infections; Prevalence; Mouth Neoplasms; Oropharyngeal Neoplasms; Head and Neck Neoplasms
PubMed: 38158517
DOI: 10.1007/s00784-023-05425-0