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Journal of the American Board of Family... 2015While the rate of head and neck cancer has decreased in recent decades, the prevalence of oropharynx cancer has dramatically increased due to human papillomavirus... (Review)
Review
While the rate of head and neck cancer has decreased in recent decades, the prevalence of oropharynx cancer has dramatically increased due to human papillomavirus (HPV)-related oropharyngeal cancer. Three of 4 newly diagnosed oropharyngeal carcinomas are HPV-positive, and by 2020 it is projected that the prevalence of this disease will overtake that of HPV-related cervical cancer. Recognized in recent years as a malignant entity distinct from HPV-negative oropharyngeal carcinoma, HPV-positive oropharyngeal cancer is associated with younger age at diagnosis, oral sexual behavior as a primary risk factor, nonspecific presentation, and improved treatment response compared with HPV-negative disease. Early recognition and referral for definitive treatment are paramount in decreasing morbidity and mortality, as well as improving the quality of life of these patients. Primary care providers are in an ideal position to improve patient outcomes through early recognition and referral, as well as coordination of comprehensive care of patients with this potentially devastating disease. Awareness of risk factors, a high index of suspicion, counseling patients and parents on the importance of vaccination against HPV, and coordinated care between primary care providers and specialists are vital to achieving improved outcomes for patients with this increasingly prevalent cancer.
Topics: Early Detection of Cancer; Humans; Oropharyngeal Neoplasms; Papillomavirus Infections; Papillomavirus Vaccines; Physician's Role; Prevalence; Primary Health Care; Risk Factors; United States
PubMed: 26152442
DOI: 10.3122/jabfm.2015.04.140301 -
International Journal of Radiation... Jan 2024
Topics: Humans; Human Papillomavirus Viruses; Induction Chemotherapy; Oropharyngeal Neoplasms; Carcinoma, Squamous Cell; Papillomavirus Infections; Papillomaviridae
PubMed: 38049223
DOI: 10.1016/j.ijrobp.2023.09.035 -
European Journal of Cancer (Oxford,... Aug 2022Our objective was to develop a predictive model using a machine learning signature to identify patients at high risk of relapse or death after treatment for HPV-positive...
OBJECTIVES
Our objective was to develop a predictive model using a machine learning signature to identify patients at high risk of relapse or death after treatment for HPV-positive oropharyngeal carcinoma.
MATERIALS AND METHODS
Pre-treatment variables of 450 patients with HPV-positive oropharyngeal carcinoma treated with a curative intent comprised clinical items, imaging parameters and histological findings. The events considered were progression or residual disease after treatment, the recurrent disease after a disease-free interval and death. The endpoints were the prediction of events and progression-free survival. After feature Z-score normalisation and selection, random forest classifier models were trained. The best models were evaluated on recall, the F-score, and the ROC AUC metric. The clinical relevance of the best prediction model was evaluated using Kaplan-Meier analysis with a log-rank test.
RESULTS
The best random forest model predicted the 5-year risk of relapse-free survival with a recall of 79.1%, an F1-score of 81.08%, and an AUC of the ROC curve of 0.89. The models performed poorly for the prediction of specific events of progression only, recurrence only or death only. The clinical relevance of the model was validated with a 5-year relapse-free survival of high-risk patients versus low-risk patients of 23.5% and 80%, respectively (p < 0.0001).
CONCLUSION
Patients with HPV-driven oropharyngeal carcinoma at high risk of relapse-free survival could be identified with a predictive machine learning model using patient data before treatment.
Topics: Carcinoma; Humans; Machine Learning; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis; Retrospective Studies
PubMed: 35714450
DOI: 10.1016/j.ejca.2022.05.003 -
ORL; Journal For Oto-rhino-laryngology... 2022The study objective was to identify practice patterns in oropharyngeal cancer management from 2010 to 2016 among human papillomavirus (HPV)-associated and...
INTRODUCTION
The study objective was to identify practice patterns in oropharyngeal cancer management from 2010 to 2016 among human papillomavirus (HPV)-associated and non-HPV-associated oropharyngeal squamous-cell carcinoma (OPSCC) patients.
METHODS
The National Cancer Database was utilized to identify OPSCC patients from 2010 to 2016. Frequency distributions and multivariable analyses were generated to identify practice patterns and predictors of treatment modality.
RESULTS
A total of 35,956 patients with nonmetastatic OPSCC were included. HPV status was not associated with a treatment modality preference. At academic centers, the proportion of HPV-associated OPSCC patients versus non-HPV-associated OPSCC patients undergoing surgical management was similar (35.7%; 35.9%). Community cancer programs treated patients less often surgically but with no significant treatment preference based on HPV status. Within each facility type, HPV status was not a predictor of surgical or nonsurgical management.
CONCLUSION
HPV association does not appear to significantly influence treatment modality preference among OPSCC patients. The proportion of OPSCC patients undergoing surgical treatment declined from 2010 to 2016.
Topics: Humans; Papillomaviridae; Alphapapillomavirus; Papillomavirus Infections; Carcinoma, Squamous Cell; Prognosis; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms
PubMed: 36067748
DOI: 10.1159/000524752 -
Head & Neck Dec 2016Treatment of recurrent oropharyngeal cancer is widely thought to have poor outcomes. Justification for treatment, especially in advanced cases, can be difficult. (Comparative Study)
Comparative Study Meta-Analysis Review
Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: A systematic review and meta-analysis.
BACKGROUND
Treatment of recurrent oropharyngeal cancer is widely thought to have poor outcomes. Justification for treatment, especially in advanced cases, can be difficult.
METHODS
A systematic search of MEDLINE, Embase, and Cochrane databases was conducted. Included studies reported specific recurrent oropharyngeal cancer survival data.
RESULTS
Twenty-two retrospective studies were included. Pooled 3-year overall survival (OS) was 26% (95% confidence interval [CI] = 22% to 29%; I squared = 40.7%; p = .057). Pooled 5-year OS was 23% (95% CI = 20% to 27%; I squared = 73.9%; p = .000). Surgical treatment was superior to radiation (5-year OS 26% vs 16%, respectively; p < .001). The 5-year OS improved over time: 18% in the pre-2000 cohort; 35% in the mixed pre-2000 and post-2000 group; and 51% in the post-2000 cohort (p < .001).
CONCLUSION
Outcomes have improved considerably over the last 2 decades, resulting in approximately 50% overall 5-year survival. Human papillomavirus (HPV) status, patient selection, and improvements in care may explain this. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38: 1855-1861, 2016.
Topics: Chemoradiotherapy; Female; Humans; Male; Neoplasm Recurrence, Local; Neoplasm, Residual; Oropharyngeal Neoplasms; Pharyngectomy; Prognosis; Risk Assessment; Survival Analysis; Treatment Outcome
PubMed: 27405247
DOI: 10.1002/hed.24531 -
Otolaryngology--head and Neck Surgery :... Apr 2014To assess the incidence, treatment methods, and outcomes of oropharyngeal squamous cell carcinoma (OPSCC) in patients younger than 45 years.
OBJECTIVES
To assess the incidence, treatment methods, and outcomes of oropharyngeal squamous cell carcinoma (OPSCC) in patients younger than 45 years.
STUDY DESIGN
Retrospective population based.
SETTING
Surveillance Epidemiology End Results (SEER) 9 database.
SUBJECTS AND METHODS
The SEER 9 database was queried from 1973 to 2009 for OPSCC patients <45 years of age.
RESULTS
There were 1603 patients with OPSCC younger than 45 years. The incidence in patients between 36 and 44 years increased from 0.79 to 1.39 (per 100,000). In the same time period, there was an increase in the rate from 0.20 to 0.42 in whites and a decrease in the rate in African American (AA) patients from 0.67 to 0.32. The proportion of grade III/IV tumors also steadily increased from 28% in 1973 to 1979 to 43% in 2000 to 2009 (P < .0001). Surgery alone was performed in 220 patients (13.72%) and in combination with radiation therapy in 734 patients (45.79%). Five-year survival for the study cohort is 54%. Compared with white patients, AA patients had worse survival (P < .0001). Patients who had surgery, either alone (localized stage patients) or in combination with radiation, had the highest 5-year survival followed by those who had radiation.
CONCLUSIONS
There was an increase in OPSCC in the study patients within the past 4 decades, particularly in those aged 36 to 44 years. Interestingly, the incidence in whites increased and in AA patients it decreased. It is important to note that most of these patients were treated with surgery, either alone or with radiation therapy. The rising incidence within recent decades is thought to be related to human papillomavirus transmission and changes in sexual practices.
Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cohort Studies; Databases, Factual; Disease-Free Survival; Female; Humans; Incidence; Kaplan-Meier Estimate; Laryngectomy; Male; Middle Aged; Neck Dissection; Neoplasm Invasiveness; Neoplasm Staging; Oropharyngeal Neoplasms; Prognosis; Retrospective Studies; Risk Assessment; SEER Program; Sex Distribution; Survival Analysis; Tonsillectomy; Young Adult
PubMed: 24452304
DOI: 10.1177/0194599813519738 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Apr 2020
Topics: Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 32306646
DOI: 10.3760/cma.j.cn115330-20190719-00449 -
European Archives of... Nov 2009
Review
Topics: Deglutition; Humans; Mouth Neoplasms; Oropharyngeal Neoplasms; Recovery of Function; Speech
PubMed: 19756680
DOI: 10.1007/s00405-009-1089-2 -
Otolaryngology--head and Neck Surgery :... Apr 2022To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting.
OBJECTIVE
To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting.
STUDY DESIGN
Retrospective chart review.
SETTING
Academic tertiary center.
METHODS
A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS.
RESULTS
A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus-associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC.
CONCLUSIONS
Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Retrospective Studies; Robotic Surgical Procedures; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome
PubMed: 34154449
DOI: 10.1177/01945998211020302 -
Oral Oncology Sep 2021
Topics: Carcinoma; Head and Neck Neoplasms; Humans; Neoplasm Metastasis; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 33883078
DOI: 10.1016/j.oraloncology.2021.105286