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The Laryngoscope May 2021We have seen several incidences of catastrophic bleeding in patients with advanced oropharyngeal squamous cell carcinoma treated nonoperatively. Aside from advanced...
OBJECTIVES/HYPOTHESIS
We have seen several incidences of catastrophic bleeding in patients with advanced oropharyngeal squamous cell carcinoma treated nonoperatively. Aside from advanced disease, these patients have not had traditional risk factors for major hemorrhage.
STUDY DESIGN
Retrospective chart review.
METHODS
Patients treated nonoperatively for oropharyngeal squamous cell carcinoma were compared to determine characteristics that may predisposed to bleeding. Five patients with bleeding were identified and compared with a cohort of stage- and treatment-matched patients without bleeding. Blinded imaging review was performed to characterize the tumor site and its relationship to vasculature using standardized systems.
RESULTS
Comparing the bleeder versus nonbleeder groups pre-treatment, the bleeder group had larger tumors (15.4 vs. 8.3 cm ), greater rates of parapharyngeal fat effacement (80% vs. 20%), and always involved the facial artery. Post-treatment, endophytic ulcerated tumor beds occurred in 100% of bleeders versus 0% of nonbleeders.
CONCLUSIONS
Catastrophic oropharyngeal bleeding may be encountered after cytoreductive therapy. Large deeply invasive tumors seem to set the necessary circumstances. Rapid vascular control with interventional radiology has been largely effective therapy.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:1049-1052, 2021.
Topics: Aged; Antineoplastic Agents; Chemoradiotherapy; Disease-Free Survival; Female; Hemorrhage; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oropharyngeal Neoplasms; Oropharynx; Radiology, Interventional; Radiotherapy, Intensity-Modulated; Retrospective Studies; Risk Assessment; Severity of Illness Index; Squamous Cell Carcinoma of Head and Neck; Tomography, X-Ray Computed
PubMed: 33068291
DOI: 10.1002/lary.29167 -
Journal of the American Society of... 2020Human papillomavirus (HPV)-related oropharyngeal carcinoma can morphologically mimic many processes from benign to malignant and lead pathologists to incorrectly... (Review)
Review
Human papillomavirus (HPV)-related oropharyngeal carcinoma can morphologically mimic many processes from benign to malignant and lead pathologists to incorrectly diagnose them and/or use inappropriate diagnostic terminology. Recognition of HPV-related oropharyngeal carcinoma and its variants is critical for appropriate prognostic and therapeutic considerations in small biopsy material. Various pitfalls in diagnosing these tumors on limited biopsies are discussed herein.
Topics: Adult; Biomarkers, Tumor; Biopsy, Needle; Cyclin-Dependent Kinase Inhibitor p16; DNA, Viral; Female; Human papillomavirus 16; Humans; Immunohistochemistry; In Situ Hybridization; Male; Middle Aged; Oropharyngeal Neoplasms; Oropharynx; Papillomavirus Infections; Polymerase Chain Reaction; Squamous Cell Carcinoma of Head and Neck
PubMed: 32651129
DOI: 10.1016/j.jasc.2020.06.001 -
Pathology Dec 2021Tumour infiltrating lymphocytes (TILs) have been described as a biomarker for the host immune response against the tumour with prognostic properties. The International...
Tumour infiltrating lymphocytes (TILs) have been described as a biomarker for the host immune response against the tumour with prognostic properties. The International Immuno-Oncology Biomarkers Working Group (IBWG) proposed a standardised method for quantifying TILs in solid tumours to improve consistent and reproducible scoring. In this study, the methodology was tested in a retrospective population of oropharyngeal squamous cell carcinoma (OPSCC). TIL quantification was performed on 92 OPSCC samples (2004-2013) by four independent observers as described by the IBWG. Interobserver variability was assessed and results were correlated with clinicopathological variables and survival. TIL evaluation turned out to be challenging in OPSCC due to heterogeneity of TILs distribution, presence of pre-existing lymphoid tissue, surface ulceration or erosion and insufficient amount of intertumoural stroma in biopsies. Nonetheless, interobserver variability proved to be good to excellent. High stromal TILs (TILstr) and intratumoural TILs (TILtum) were both correlated to favourable overall survival and multivariate analysis showed TILstr to be the sole independent prognostic factor in OPSCC. The IBWG-proposed TIL quantification method is feasible and reproducible in OPSCC and provides valuable prognostic information regarding clinicopathological characteristics and overall survival. The use of this standardised methodology may facilitate implementation of TILs scoring as a prognostic biomarker in OPSCC.
Topics: Biomarkers, Tumor; Head and Neck Neoplasms; Humans; Lymphocytes, Tumor-Infiltrating; Oropharyngeal Neoplasms; Prognosis; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Tumor Microenvironment
PubMed: 34217516
DOI: 10.1016/j.pathol.2021.03.005 -
Head & Neck Sep 2012The purpose of this study was to assess the efficacy of primary transoral surgery in the management of T1 oropharyngeal carcinoma.
BACKGROUND
The purpose of this study was to assess the efficacy of primary transoral surgery in the management of T1 oropharyngeal carcinoma.
METHODS
A retrospective evaluation was conducted on the files of all patients treated with primary surgery for pT1 oropharyngeal carcinoma at a tertiary referral center between 1976 and 2005.
RESULTS
A total of 223 cases were assessed. Disease-specific survival was 88% and local control 93%. Transoral surgery with the use of CO(2) laser or electrocautery was adopted in every case. Positive surgical margins and regional disease were found to significantly worsen prognosis. A low rate of complications and satisfactory retention of pharyngeal function were noted.
CONCLUSIONS
Primary transoral surgical treatment is very effective against T1 oropharyngeal carcinoma. A low rate of complications should be expected. However, in every case complete excision of the tumor must be accomplished and the neck included in the primary treatment plan.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Retrospective Studies; Survival Analysis
PubMed: 22084028
DOI: 10.1002/hed.21916 -
HNO Apr 2016Treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC) requires interdisciplinary collaboration. Besides oncologic control, organ and function... (Review)
Review
Treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC) requires interdisciplinary collaboration. Besides oncologic control, organ and function preservation are important priorities. One treatment option is primary concomitant chemoradiotherapy (CRT), particularly for locally advanced head and neck cancer. Another option is sequential CRT, where induction chemotherapy may be followed either by radiation alone or by CRT. An important aspect of these modalities is the development of functional sequelae with regards to swallowing as a direct consequence of radiogenic fibrosis, as well as tissue ctoxicity associated with cisplatin-based chemotherapy. Conventional open surgical approaches are being increasingly replaced by transoral surgical modalities with less treatment-related morbidity. As a further, equally important goal of appropriately indicated surgery, adjuvant (C)RT may be omitted or the dose significantly reduced. The advantages of primary surgery over primary CRT may be less obvious in cases still requiring adjuvant treatment, although not necessarily completely eliminated. For patients with human papillomavirus (HPV)-driven OPSCC, it is important to note that primary surgery may provide comparable or even increased survival benefit. To date, there is no evidence for a clear advantage of primary CRT over primary surgery in this group. In these cases, a de-escalated treatment package may be the preferred option. Here, the application of radioimmunotherapy as well as a reduced radiation dose may minimize long-term treatment-related morbidities.
Topics: Chemoradiotherapy; Evidence-Based Medicine; Forecasting; Germany; Humans; Medical Oncology; Neoplasms, Squamous Cell; Oropharyngeal Neoplasms; Otolaryngology; Treatment Outcome
PubMed: 26992383
DOI: 10.1007/s00106-016-0147-5 -
Current Opinion in Otolaryngology &... Aug 2005Evidence is growing that human papilloma virus is responsible for a subset of head and neck carcinomas. This review analyzes the history and current thinking regarding... (Review)
Review
PURPOSE OF REVIEW
Evidence is growing that human papilloma virus is responsible for a subset of head and neck carcinomas. This review analyzes the history and current thinking regarding this relatively new etiologic agent of squamous cell carcinoma.
RECENT FINDINGS
Research over the past year has confirmed that human papilloma virus is associated with subset of head and neck squamous cell carcinoma, especially tumors arising from the tonsil. Human papilloma virus 16 is the most common strain found in these tumors. Most studies also indicate that patients with human papilloma virus infection are more likely to have a better prognosis, engage in riskier sexual behavior, and have a history of less tobacco and alcohol consumption than patients who have human papilloma virus-negative tumors. Not all studies confirm these findings, however, and human papilloma virus, even the high-risk strains (16, 18, and 33) are found in a certain percentage of healthy individuals.
SUMMARY
Human papilloma virus (especially strain 16) has been recognized as a probable etiologic agent for some head and neck squamous cell carcinomas. Most commonly, human papilloma virus is associated with tumors arising from the tonsillar epithelium. Because a definitive causal relationship is still to be identified, current research aims to delineate the specific mechanism whereby human papilloma virus produces squamous cell carcinoma. It is hoped that a vaccine may be produced in the near future that will serve as adjuvant therapy for patients with human papilloma virus-positive tumors.
Topics: Carcinoma, Squamous Cell; Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Tumor Virus Infections
PubMed: 16012244
DOI: 10.1097/01.moo.0000170524.74264.b1 -
Journal of Oncology Practice Nov 2016The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe... (Review)
Review
The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe d'Oncologie Radiothérapie Tête et Cou trial. Since that time, human papillomavirus-associated oropharyngeal squamous cell carcinoma has been identified as a unique disease, with improved survival regardless of treatment modality. The improved outcomes of this population has led to re-evaluation of treatment paradigms in the past decade, with a desire to spare young, human papillomavirus-positive patients the treatment-related toxicities of chemoradiotherapy and to use new minimally invasive surgical techniques to improve outcomes. Numerous retrospective and prospective studies have investigated the role of surgery in treatment of oropharyngeal carcinoma and have demonstrated equivalent oncologic outcomes and improved functional outcomes compared with chemoradiotherapy protocols. Ongoing and future clinical trials may help delineate the role of surgery in the future.
Topics: Humans; Lasers; Microsurgery; Neoplasms, Unknown Primary; Oropharyngeal Neoplasms; Robotic Surgical Procedures
PubMed: 27858544
DOI: 10.1200/JOP.2016.015263 -
Cancer Science Dec 2013Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas (OPSCCs) frequently show different clinical and pathological features, which tend to be... (Review)
Review
Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas (OPSCCs) frequently show different clinical and pathological features, which tend to be younger age, better performance status, less tobacco and alcohol consumption, more poorly differentiated histopathology, but usually with better treatment response and prognosis compared with HPV-negative OPSCCs. In tumor tissue, HPV infection is closely correlated with p16(INK4A) expression, which has been suggested to be a surrogate biomarker of HPV infection. However, there is diversity of sensitivity and specificity about p16(INK4A) in surrogate detection of HPV status. Herein, we summarize the current knowledge and note some aspects for consideration concerning p16(INK4A) as a surrogate biomarker for HPV-associated OPSCC.
Topics: Alphapapillomavirus; Biomarkers, Tumor; Cyclin-Dependent Kinase Inhibitor p16; DNA, Viral; Humans; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis
PubMed: 24344719
DOI: 10.1111/cas.12287 -
Clinical Oncology (Royal College of... May 2021To analyse outcomes and patterns of failure in patients with oropharyngeal carcinoma (OPC) treated with definitive volumetric modulated arc therapy with omission of...
Radiotherapy for Oropharyngeal Carcinoma With an Uninvolved Contralateral Neck: The Safety of Omission of Contralateral High Level II and Retropharyngeal Lymph Nodes From Elective Target Volumes.
AIMS
To analyse outcomes and patterns of failure in patients with oropharyngeal carcinoma (OPC) treated with definitive volumetric modulated arc therapy with omission of contralateral high level II lymph nodes (HLII) and retropharyngeal lymph nodes (RPLN) in the contralateral uninvolved neck.
MATERIALS AND METHODS
Patients with OPC treated between January 2016 and July 2019 were retrospectively identified. In the absence of contralateral neck disease, institutional protocols allowed omission of contralateral HLII and contralateral RPLN in the additional absence of ipsilateral RPLN, soft palate/posterior pharyngeal wall primary.
RESULTS
In total, 238 patients with OPC and an uninvolved contralateral neck received definitive (chemo)radiotherapy with bilateral neck treatment. The median follow-up was 30.6 months. Two-year local control, regional control and overall survival were 91.0, 91.6 and 86.5%, respectively. Contralateral HLII were omitted in 159/238 (66.8%) patients; this included 106 patients in whom the primary tumour was at/crossed the midline. The contralateral RPLN region was omitted from elective target volumes for 175/238 (73.5%); this included 114 patients with a primary tumour at/crossed the midline. The mean contralateral parotid dose when contralateral HLII and RPLN were both omitted was 24.4 Gy, compared with 28.3 Gy without HLII/RPLN omission (P < 0.001). Regional progression occurred in 18/238 (7.6%) patients, all involving the ipsilateral neck with one bilateral. There were no recurrences in the contralateral HLII or RPLN regions.
CONCLUSION
In patients with OPC and an uninvolved contralateral neck receiving bilateral (chemo)radiotherapy, the omission of contralateral RPLN and HLII from elective target volumes was safe and could lead to reduced contralateral parotid doses.
Topics: Carcinoma; Humans; Lymph Nodes; Neoplasm Staging; Oropharyngeal Neoplasms; Retrospective Studies
PubMed: 33358282
DOI: 10.1016/j.clon.2020.12.007 -
Clinical Oncology (Royal College of... Jul 2016The management of oropharyngeal carcinoma represents an increasing clinical challenge, because of its rising incidence, particularly in younger patients as a result of... (Comparative Study)
Comparative Study
The management of oropharyngeal carcinoma represents an increasing clinical challenge, because of its rising incidence, particularly in younger patients as a result of human papillomavirus (HPV) infection, and because significant technological advances have occurred in radiotherapy and surgery over the last 10 years that have increased treatment options for patients, with little robust evidence yet of their relative merits. As a result, there is a lack of clinical consensus on the optimum treatment modality, reflected in wide variation in practice between different cancer networks across the UK. Here, we consider the evidence base for minimally invasive transoral surgery and for intensity-modulated radiotherapy-based primary treatment for oropharyngeal cancer, in terms of both oncological and functional outcomes. Management strategies for HPV-positive and HPV-negative disease, and for different stages of the disease, are considered. There is currently an unparalleled opportunity to shape the future management of oropharyngeal cancer, which is dependent on recruiting patients to ongoing clinical trials, in order to build an evidence base to support a clinical consensus on the optimal treatment strategies. It appears likely that future evidence-based decision-making will use both primary radiotherapy and primary surgical treatment modalities to maximise patient benefit.
Topics: Carcinoma, Squamous Cell; Humans; Neoplasm Staging; Oral Surgical Procedures; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Radiotherapy, Intensity-Modulated
PubMed: 26988463
DOI: 10.1016/j.clon.2016.02.010