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BMJ (Clinical Research Ed.) Mar 2010
Topics: Humans; Oropharyngeal Neoplasms; Papillomavirus Infections
PubMed: 20339160
DOI: 10.1136/bmj.c1439 -
Magyar Onkologia Sep 2018Over the past decade, human papillomavirus-related oropharyngeal squamous cell carcinoma has become a distinct entity that differs from conventional head and neck cancer... (Review)
Review
Over the past decade, human papillomavirus-related oropharyngeal squamous cell carcinoma has become a distinct entity that differs from conventional head and neck cancer in many ways including its epidemiology, genetics, tumor behavior, and prognosis. Human papillomavirus-related oropharyngeal squamous cell carcinomas also exhibit characteristic histologic features. This review will cover the histomorphologic appearances of human papillomavirus-related oropharyngeal carcinoma, with an emphasis on their differences from conventional, human papillomavirus-unrelated cancer. Besides these we summarize the mechanism of carcinogenesis and the last guidelines for diagnosing this type of cancers.
Topics: Carcinoma, Squamous Cell; Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 30256879
DOI: No ID Found -
Head & Neck Apr 2021Pathologic features of oropharyngeal squamous cell carcinoma (OPSCC) treated with trans-oral robotic surgery predict prognosis and adjuvant therapy. We hypothesized that...
BACKGROUNDS
Pathologic features of oropharyngeal squamous cell carcinoma (OPSCC) treated with trans-oral robotic surgery predict prognosis and adjuvant therapy. We hypothesized that pathologic muscle invasion (pMI) is associated with poor pathological markers.
METHODS
Retrospective review of surgically treated OPSCC to identify pMI and its association with poor pathologic markers.
RESULTS
pMI was present in 12/37 patients, and compared to non-pMI, was associated with higher rates of lymphovascular invasion (75% vs. 36%, p = 0.03), perineural invasion (16.7% vs. 0%, p = 0.04), extranodal extension (66.7% vs. 20%, p < 0.01), and tumor stage (8.3% vs. 48% pT1, 75% vs. 52% pT2 and 16.7% vs. 0% pT3). pMI was associated with having a positive margin on main specimen (41.7% vs. 12%, p = 0.04) but not after considering additional margins.
CONCLUSIONS
Muscle invasion was associated with higher pathologic tumor staging, poor pathologic factors, and higher rates of positive margin on main specimen.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Muscles; Neoplasm Staging; Oropharyngeal Neoplasms; Retrospective Studies; Robotic Surgical Procedures
PubMed: 33355962
DOI: 10.1002/hed.26582 -
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 -
International Journal of Cancer Apr 2015Due to the generally poor prognosis of head and neck squamous cell carcinoma (HNSCC), treatment has been intensified, these last decades, leading to an increase of... (Review)
Review
Due to the generally poor prognosis of head and neck squamous cell carcinoma (HNSCC), treatment has been intensified, these last decades, leading to an increase of serious side effects. High-risk human papillomavirus (HR-HPV) infection has been recently etiologically linked to a subset of oropharyngeal squamous cell carcinoma (OPSCC), which is on the increase. These tumors are different, at the clinical and molecular level, when compared to tumors caused by traditional risk factors. Additionally, their prognosis is much more favorable which has led the medical community to consider new treatment strategies. Indeed, it is possible that less intensive treatment regimens could achieve similar efficacy with less toxicity and improved quality of life. Several clinical trials, investigating different ways to de-escalate treatment, are currently ongoing. In this article, we review these main approaches, discuss the rationale behind them and the issues raised by treatment de-escalation in HPV-positive OPSCC.
Topics: Cancer Vaccines; Clinical Trials as Topic; Combined Modality Therapy; Humans; Oropharyngeal Neoplasms; Papillomavirus Infections; Treatment Outcome
PubMed: 24622970
DOI: 10.1002/ijc.28847 -
Radiotherapy and Oncology : Journal of... Jul 2023This study provides a review of the literature assessing whether semiquantitative PET parameters acquired at baseline and/or during definitive (chemo)radiotherapy... (Review)
Review
Prognostic and predictive values of baseline and mid-treatment FDG-PET in oropharyngeal carcinoma treated with primary definitive (chemo)radiation and impact of HPV status: Review of current literature and emerging roles.
BACKGROUND AND PURPOSE
This study provides a review of the literature assessing whether semiquantitative PET parameters acquired at baseline and/or during definitive (chemo)radiotherapy ("prePET" and "iPET") can predict survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPC), and the impact of human papilloma virus (HPV) status.
MATERIAL AND METHODS
A literature search was carried out using PubMed and Embase between 2001 to 2021 in accordance with PRISMA.
RESULTS
The analysis included 22 FDG-PET/CT studies [1-22], 19 pre-PET and 3 both pre-PET and iPET, The analysis involved 2646 patients, of which 1483 are HPV-positive (17 studies: 10 mixed and 7 HPV-positive only), 589 are HPV-negative, and 574 have unknown HPV status. Eighteen studies found significant correlations of survival outcomes with pre-PET parameters, most commonly primary or "Total" (combined primary and nodal) metabolic tumour volume and/or total lesional glycolysis. Two studies could not establish significant correlations and both employed SUVmax only. Two studies also could not establish significant correlations when taking into account of the HPV-positive population only. Because of the heterogeneity and lack of standardized methodology, no conclusions on optimal cut-off values can be drawn. Ten studies specifically evaluated HPV-positive patients: five showed positive correlation of pre-PET parameters and survival outcomes, but four of these studies did not include advanced T or N staging in multivariate analysis, and two studies only showed positive correlations after excluding high risk patients with smoking history or adverse CT features. Two studies found that prePET parameters predicted treatment outcomes only in HPV-negative but not HPV-positive patients. Two studies found that iPET parameters could predict outcomes in HPV-positive patients but not prePET parameters.
CONCLUSION
The current literature supports high pre-treatment metabolic burden prior to definitive (chemo)radiotherapy can predict poor treatment outcomes for HPV-negative OPC patients. Evidence is conflicting and currently does not support correlation in HPV-positive patients.
Topics: Humans; Prognosis; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Human Papillomavirus Viruses; Carcinoma, Squamous Cell; Oropharyngeal Neoplasms; Head and Neck Neoplasms; Retrospective Studies; Radiopharmaceuticals
PubMed: 37142128
DOI: 10.1016/j.radonc.2023.109686 -
European Archives of... Oct 2016HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the... (Review)
Review
HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.
Topics: Aged; Antineoplastic Agents; Carcinoma, Squamous Cell; Chemoradiotherapy; Cyclin-Dependent Kinase Inhibitor p16; Female; Humans; Induction Chemotherapy; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Radiation Tolerance; Smoking; Tumor Escape
PubMed: 26463714
DOI: 10.1007/s00405-015-3771-x -
Anticancer Research Nov 2022Post-treatment surveillance of patients with squamous cell oropharyngeal carcinoma (SCOPC) consists of routine follow-up visits for 5 years. It has been suggested that...
BACKGROUND/AIM
Post-treatment surveillance of patients with squamous cell oropharyngeal carcinoma (SCOPC) consists of routine follow-up visits for 5 years. It has been suggested that this program is inefficient for finding recurrences and increasing survival. The primary study objective was to investigate how recurrences after treatment for SCOPC were detected, i.e., at routine follow-up visits, at patient-initiated visits, or incidentally. The secondary objective was to investigate whether 2-year survival after diagnosis of recurrence depended on the manner of detection.
PATIENTS AND METHODS
Patients with recurrences from SCOPC between 1988 and 2018 were included. Survival was analysed by the Kaplan-Meier method with log-rank test.
RESULTS
A total of 75 patients were included. Almost one-third were alive 2 years after the diagnosis of recurrence. Recurrences were detected at routine follow-up visits in 50.7%, at patient-initiated visits in 42.7% and 6.6% were found incidentally. There was an increased survival in the patient-initiated group, but this was not significant.
CONCLUSION
The majority of recurrences in both groups compared were amenable to curative treatment.
Topics: Humans; Neoplasm Recurrence, Local; Follow-Up Studies; Oropharyngeal Neoplasms; Carcinoma, Squamous Cell; Retrospective Studies
PubMed: 36288847
DOI: 10.21873/anticanres.16067 -
The Cochrane Database of Systematic... Dec 2016More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human... (Review)
Review
BACKGROUND
More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important.
OBJECTIVES
To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy.
SEARCH METHODS
The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016.
SELECTION CRITERIA
Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score.
MAIN RESULTS
No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016.
AUTHORS' CONCLUSIONS
The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Humans; Laser Therapy; Microsurgery; Oropharyngeal Neoplasms; Radiotherapy, Adjuvant; Robotic Surgical Procedures
PubMed: 27943254
DOI: 10.1002/14651858.CD010963.pub2 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2022In recent years, the incidence of oropharyngeal carcinoma (OPC) is increasing, while the better prognosis of patients with Human papillomavirus (HPV) positive...
In recent years, the incidence of oropharyngeal carcinoma (OPC) is increasing, while the better prognosis of patients with Human papillomavirus (HPV) positive oropharyngeal carcinoma has been confirmed in a number of studies. There are a variety of detection methods for HPV-associated oropharyngeal carcinoma. Including P16 immunohistochemistry, Polymerase Chain Reaction (PCR) or In situ hybridization (ISH) detection of HPV DNA, HPV RNA, Revers transcriptase Polymerase Chain Reaction (RT PCR) was used to detect HPV RNA. The better prognosis of patients with HPV-positive oropharyngeal carcinoma has led to the emergence of a large number of degraded treatment trials. The traditional P16 test has certain limitations in the diagnosis of patients with HPV-positive oropharyngeal carcinoma. It is necessary to combine with other detection methods to accurately screen out patients with HPV-positive oropharyngeal carcinoma and better apply to degraded therapy. In this article, we will briefly introduce the trend of HPV-associated oropharyngeal carcinoma, the detection methods and the new progress of degraded treatment trials.
Topics: Carcinoma, Squamous Cell; Cyclin-Dependent Kinase Inhibitor p16; DNA, Viral; Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; RNA
PubMed: 36217663
DOI: 10.13201/j.issn.2096-7993.2022.10.015