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Head & Neck Apr 2012Recent studies of oropharyngeal carcinoma have reported remarkable correlation between integrated human papillomavirus (HPV) viral detection and p16 protein...
Recent studies of oropharyngeal carcinoma have reported remarkable correlation between integrated human papillomavirus (HPV) viral detection and p16 protein overexpression in tumor cells. These findings led to calls for the substitution of p16 expression for the more demanding HPV testing in clinical practice. The rationale for such practice is largely driven by the simplicity, low cost, and the feasibility of the immunohistochemical (IHC) analysis. There are, however, several caveats that need to be fully considered. These include the subjective nature of IHC evaluation, the variable mechanisms of p16 expression in head and neck squamous cell carcinoma, and the lack of scoring and interpretive criteria. This perspective addresses the conceptual and practical issues associated with the p16 expression analysis and provides a broad outline for its application and evaluation in patients with oropharyngeal carcinoma.
Topics: Biomarkers, Tumor; Biopsy, Needle; Carcinoma, Squamous Cell; Cyclin-Dependent Kinase Inhibitor p16; Female; Gene Expression Regulation, Neoplastic; Human papillomavirus 16; Humans; Immunohistochemistry; Male; Neoplasm Proteins; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis; Sensitivity and Specificity
PubMed: 22180304
DOI: 10.1002/hed.21974 -
Head & Neck Nov 2022To assess intra- and inter-institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+...
OBJECTIVES
To assess intra- and inter-institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma.
METHODS
Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase-I (20 cases) utilized each individual's a priori appreciation of the literature. Phase-II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra- and inter-institutional Kappa were calculated at >50% and >75% certainty levels, respectively.
RESULTS
The Phase-I intra-institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter-institutional Fleiss' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase-II inter-rater kappa was significantly higher than Phase-I at the same certainty level (both p < 0.001).
CONCLUSION
A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.
Topics: Carcinoma; Extranodal Extension; Humans; Observer Variation; Oropharyngeal Neoplasms; Papillomavirus Infections; Reproducibility of Results
PubMed: 35766141
DOI: 10.1002/hed.27130 -
The Laryngoscope Oct 2017Much of what is known about the significance of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is derived from single-institution retrospective...
OBJECTIVE
Much of what is known about the significance of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is derived from single-institution retrospective studies, post hoc analyses of tissue specimens from clinical trials, and tissue bank studies with a small sample size. The objective of this study is to investigate the impact of HPV on the frequency and clinical presentation of oropharyngeal carcinoma in a large, national sample with information from patients who underwent HPV testing.
STUDY DESIGN
Retrospective, cross-sectional study.
METHODS
We identified a comprehensive national sample of 8,359 patients with oropharyngeal carcinoma and known HPV status diagnosed between 2010 and 2011 within the National Cancer Database. Multivariable logistic regression was used to assess correlates of patient and tumor characteristics on HPV status.
RESULTS
Among patients with oropharyngeal carcinoma, the frequency of HPV-related squamous cell carcinoma in the United States was 65.4%. HPV-related oropharyngeal carcinoma was associated with younger age, male sex, and white race (P < 0.001). Advanced primary tumor stage was associated with HPV-negative disease (P < 0.001), whereas increasing nodal burden was associated with HPV-positive disease (P < 0.001). Despite less-advanced nodal disease, HPV-negative tumors were associated with a higher likelihood of metastasis at presentation (P < 0.001).
CONCLUSION
HPV now accounts for the majority of newly diagnosed oropharyngeal carcinoma in the United States and is associated with a distinct clinical profile, supporting efforts to re-evaluate the staging and treatment paradigm for HPV-associated oropharyngeal cancer.
LEVEL OF EVIDENCE
4. Laryngoscope, 127:2270-2278, 2017.
Topics: Adolescent; Adult; Aged; Carcinoma; Cross-Sectional Studies; Databases, Factual; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Retrospective Studies; Risk Factors; United States; Young Adult
PubMed: 28304083
DOI: 10.1002/lary.26566 -
Auris, Nasus, Larynx Aug 2022Over time, the primary treatment modality of oropharyngeal squamous cell cancers (OPSCC) is intensity-modulated radiation therapy (IMRT), eventually associated with... (Review)
Review
Over time, the primary treatment modality of oropharyngeal squamous cell cancers (OPSCC) is intensity-modulated radiation therapy (IMRT), eventually associated with chemotherapy (CHT). This treatment modality is preferred for reduced impact on the quality of life rather than aggressive open surgical approaches. The advent of TransOral Robotic Surgery (TORS) has rediscovered the role of surgery in the treatment of OPSCC. Although the primary chemoradiation therapy (CRT) and transoral robotic surgery (TORS) are competing for similar oncologic results, CRT may result in significant functional complaints such as severe dysphagia and feeding tube dependence and, on the other hand, TORS might result in surgical defects depending on the size of the resection and anatomic location. Nevertheless, TORS may intercept the locoregionally advanced population through pathologic downstaging as well as the potential for improvement in oncologic outcomes. The available reconstructive options allow an expanding role of this minimally invasive surgery, even in locally advanced tumours. Finally, the surgical management of OPSCC with TORS identifies areas of opportunity in shortening the overall treatment package time compared to traditional surgery.
Topics: Chemoradiotherapy; Head and Neck Neoplasms; Humans; Oropharyngeal Neoplasms; Quality of Life; Robotic Surgical Procedures; Squamous Cell Carcinoma of Head and Neck
PubMed: 35101284
DOI: 10.1016/j.anl.2022.01.011 -
Journal of Cancer Research and... 2015In recent years there has been change in trends in the incidence of head and neck squamous cell carcinoma (HNSCC) with oropharyngeal carcinoma (OPC) showing an increased... (Review)
Review
In recent years there has been change in trends in the incidence of head and neck squamous cell carcinoma (HNSCC) with oropharyngeal carcinoma (OPC) showing an increased incidence, attributable specifically to infection by human papillomavirus (HPV). At the same time there is change in demographic characteristics and prognosis of this subset of HNSCC. Considering the better prognosis, researchers are trying to reduce the acute and long-term toxicities by alteration of various components of treatment protocols. Although treatment deintensification is an option for this group of patients, there is no standard protocol available and should be tried only in the protocol setting.
Topics: Head and Neck Neoplasms; Humans; Incidence; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prevalence
PubMed: 25879328
DOI: 10.4103/0973-1482.151445 -
Der Pathologe Mar 2014Carcinomas of the oropharynx with association to high-risk types of human papillomavirus (HPV) have been identified as a new tumour entity with favourable prognosis,... (Review)
Review
Carcinomas of the oropharynx with association to high-risk types of human papillomavirus (HPV) have been identified as a new tumour entity with favourable prognosis, distinct from classical nicotine- and alcohol-associated carcinoma. They develop through oncogenic transformation of the basal cells of reticulated cryptal epithelium of the palatinal tonsils and the base of the tongue. Positivity for HPV strongly correlates with an atypical, non-keratinizing histological differentiation and cystic transformation of lymph node metastases. Strong immunohistological positivity for p16 reliably detects transcriptionally active infection with high-risk HPV. Hence, p16 staining has been regarded as an effectual diagnostic tool in the appropriate setting. Frequent nodal metastasation as well as considerable size of (cystic) metastases, and frequent small size as well as submucosal location of primary tumours all contribute to frequent initial manifestation of cervical cancer of unknown primary (CUP). In a situation of CUP diagnostic testing for HPV (in negative cases in addition to EBV) is recommended in lymph node metastases, due to the high predictive value for the localization of occult primary carcinomas. Intense clinicopathological cooperation is mandatory for improved detection of small, occult primary carcinomas. The relevance of this new carcinoma entity will increase, as the incidence continues to increase worldwide.
Topics: Cell Transformation, Neoplastic; Cell Transformation, Viral; Human papillomavirus 16; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasms, Unknown Primary; Oropharyngeal Neoplasms; Oropharynx; Papillomavirus Infections; Terminology as Topic; Tongue Neoplasms; Tonsillar Neoplasms
PubMed: 24619523
DOI: 10.1007/s00292-013-1852-4 -
Radiotherapy and Oncology : Journal of... Jan 2020The aim was to evaluate in oropharyngeal carcinoma the: (1) incidence and predictors of retropharyngeal (RP) lymph node (LN) involvement, (2) pattern of...
INTRODUCTION
The aim was to evaluate in oropharyngeal carcinoma the: (1) incidence and predictors of retropharyngeal (RP) lymph node (LN) involvement, (2) pattern of ipsilateral/bilateral/contralateral-only RP LNs (3) location of RP LNs in relation to contouring guidelines.
METHODS
Single centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated non-surgically between 2010 and 2017. All patients had a baseline FDG PET-CT and contrast-enhanced MRI and/or CT. All cases with reported abnormal RP LNs underwent radiology review.
RESULTS
Abnormal RP LNs were identified in 40/402 (10%) of patients. On multivariate analysis, RP LN involvement was associated with posterior pharyngeal wall/soft palate primaries (OR 10.13 (95% CI 2.29-19.08), p = 0.002) and contralateral cervical LN involvement (OR 2.26 (95% CI 1.05-4.86), p = 0.036). T stage, largest LN size, levels of ipsilateral LN level involvement, HPV and smoking status did not predict risk. 5/402 (1.2%) patients had bilateral RP involvement. 3/402 patients (0.7%) had contralateral-only RP LNs. All patients with contralateral RP LNs had contralateral neck nodes or primary cancers extending across midline. In 5/40 (12.5%) cases with involved RP LNs, the RP LNs were superior to hard palate/upper edge of body of C1 vertebra.
CONCLUSIONS
RP LNs were identified in 10% of oropharyngeal carcinoma patients, and were associated with contralateral neck disease and/or posterior pharyngeal wall/soft palate primary. Contralateral RP LN involvement was rare and associated with contralateral neck disease and/or primary crossing midline, suggesting potential for omission from target volumes for selected patients. Involvement of RP LNs close to the skull base highlights the need for generous elective outlining.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Lymph Nodes; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Positron Emission Tomography Computed Tomography; Retrospective Studies; Young Adult
PubMed: 31431388
DOI: 10.1016/j.radonc.2019.07.021 -
Treatment De-intensification for HPV-associated Oropharyngeal Cancer: A Definitive Surgery Paradigm.Seminars in Radiation Oncology Oct 2021Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+OPSCC) constitutes the majority of head and neck diagnoses within the United States. Patients... (Review)
Review
Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+OPSCC) constitutes the majority of head and neck diagnoses within the United States. Patients with HPV+OPSCC have biologically and demographically distinct disease, leading to high cure rates after standard treatments. This long survivorship period coupled with the toxicity of standard treatments makes de-intensification strategies an urgent research question. Surgery has generally been avoided for HPV+OPSCC as historical surgical techniques were invasive and morbid. With the advent of minimally invasive transoral techniques, definitive surgical options are becoming more popular. Minimally invasive surgery offers unique opportunities in a de-intensification paradigm, including more detailed patient selection, radiation volume reduction, and radiation dose de-intensification. Nevertheless, careful patient selection must be exercised as surgical defects may lead to quality of life decrements beyond what is gained through de-intensification. Ongoing phase III efforts will help clarify the patient cohorts best suited for surgically oriented de-intensification.
Topics: Head and Neck Neoplasms; Humans; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Quality of Life; Squamous Cell Carcinoma of Head and Neck
PubMed: 34455988
DOI: 10.1016/j.semradonc.2021.07.001 -
Cancer Treatment Reviews Apr 2005The existence of branchiogenic carcinoma remains controversial. According to some authors, this malignancy is more conceptual than a true clinicopathologic entity. The... (Review)
Review
The existence of branchiogenic carcinoma remains controversial. According to some authors, this malignancy is more conceptual than a true clinicopathologic entity. The originally proposed diagnostic criteria of branchiogenic carcinoma have been subsequently challenged. Many reports regarding primary branchiogenic carcinoma have failed to provide sufficient evidence to distinguish this entity from nodal metastases arising from unrecognized primary tumours. There is growing evidence that the majority of branchiogenic carcinomas are in fact cystic metastases from oropharyngeal carcinoma, most commonly originating in the tonsils, and not true carcinomas arising in a branchial cleft cyst. The missing link between branchial cyst and branchiogenic squamous cell carcinoma could be fulfilled by the occurrence of in situ branchial cyst carcinomas, yet such cases are extremely rare. Isolated cystic neck lesions, necessitate a thorough search for a primary tumour, similarly to other occult primaries presenting with cervical metastases. The treatment of cervical cyst with dysplasia or carcinoma in situ includes complete surgical excision. The true branchiogenic carcinomas should be approached with postoperative irradiation to the half neck. A cervical metastatic cystic squamous carcinoma of unknown origin should be treated as for other cases of occult primaries, i.e. with surgery and radiotherapy. The data on the prognosis of branchiogenic carcinoma are scarce, though long-term survival has been reported. Further histopathologic and clinical studies are warranted in order to better understand the biology and natural history of cervical cystic lesions. The existence of true branchiogenic carcinoma remains to be verified with new clinical and molecular criteria.
Topics: Biopsy; Branchioma; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Neoplasms, Unknown Primary; Oropharyngeal Neoplasms; Prognosis
PubMed: 15847980
DOI: 10.1016/j.ctrv.2004.12.007 -
Ear, Nose, & Throat Journal Jun 2021
Topics: Aged, 80 and over; Carcinoma; Humans; Male; Medical Illustration; Oropharyngeal Neoplasms; Parotid Gland; Parotid Neoplasms
PubMed: 31569975
DOI: 10.1177/0145561319869609