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Otolaryngologic Clinics of North America Aug 2013Recent technological advances now permit the study of the entire cancer genome, which can elucidate complex pathway interactions that are not apparent at the level of... (Review)
Review
Recent technological advances now permit the study of the entire cancer genome, which can elucidate complex pathway interactions that are not apparent at the level of single genes. In this review, the authors describe innovations that have allowed for whole-exome/genome analysis of genetic and epigenetic alterations and of changes in gene expression. Studies using next-generation sequencing, array comparative genomic hybridization, methylation arrays, and gene expression profiling are reviewed, with a particular focus on findings from recent whole-exome sequencing projects. A discussion of the implications of these data on treatment and future goals for cancer genomics is included.
Topics: Biomarkers, Tumor; Carcinoma, Squamous Cell; Genes, Neoplasm; Humans; Mouth Neoplasms; Mutation; Oropharyngeal Neoplasms
PubMed: 23910469
DOI: 10.1016/j.otc.2013.04.001 -
Anticancer Research Mar 2018Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the...
BACKGROUND/AIM
Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the method of recurrence detection in HPV+ disease to determine a role for follow-up imaging.
PATIENTS AND METHODS
All HPV+ and HPV- oropharyngeal cancer patients treated at our institution from 2005-2016 with biopsy-proven recurrence were identified and their method of recurrence detection was analyzed.
RESULTS
A total of 16 HPV+ oropharyngeal cancer patients were identified to have recurrence, 12 (75%) of which experienced distant recurrence and 13 (81.3%) were detected asymptomatically with imaging at a median time of 19.7 months after initial treatment and verifying no residual disease. Twelve (75%) detections were with PET-CT. While HPV- patients (17 patients) also have a high rate of asymptomatic detection (16 patients, 94.1%), their 3-year post-recurrence survival was significantly lower at 6.5% compared to 83.6% for the HPV+ group (p<0.01).
CONCLUSION
In HPV+ patients, a large proportion of failures are asymptomatic distant metastases, which occur beyond 6 months following treatment completion, and are detected with whole body imaging alone. In light of long term post-recurrence survival observed, this preliminary data suggests that routine surveillance imaging should be further studied for HPV+ disease.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Positron Emission Tomography Computed Tomography; Retrospective Studies; Salvage Therapy; Treatment Outcome
PubMed: 29491081
DOI: 10.21873/anticanres.12380 -
Topics in Magnetic Resonance Imaging :... Aug 2007Magnetic resonance imaging (MRI) is a powerful tool for cross-sectional analysis of head and neck anatomy and pathology. This is especially true with regard to... (Review)
Review
Magnetic resonance imaging (MRI) is a powerful tool for cross-sectional analysis of head and neck anatomy and pathology. This is especially true with regard to oropharyngeal neoplasms, where soft tissue spread, nodal disease, perineural extension, and osseous involvement may significantly alter therapy and prognosis. In this article, we will provide a background on oropharyngeal cancers and MRI techniques and strategies, describing potential advantages of MRI with regard to particular anatomic subsites of the oropharynx. Future imaging trends in perfusion and diffusion MRI of such cancers are also discussed.
Topics: Humans; Magnetic Resonance Imaging; Neoplasm Staging; Oropharyngeal Neoplasms; Tomography, X-Ray Computed
PubMed: 17893589
DOI: 10.1097/RMR.0b013e318157112a -
Oral Oncology Feb 2021Human papillomavirus is responsible of approximately 70% oropharyngeal tumours and is related with more favourable outcomes. It has led to an increasing interest for... (Review)
Review
Human papillomavirus is responsible of approximately 70% oropharyngeal tumours and is related with more favourable outcomes. It has led to an increasing interest for de-escalation treatment strategies such as Trans Oral Robotic Surgery (TORS). A literature review was performed searching for the role of TORS as de-escalation modality of treatment in patients with p16 positive oropharyngeal squamous cell carcinoma (OPSCC). Special attention was paid to the potential advantage offered by TORS in reducing adjuvant radiation therapy. Six questions were formulated. 67 studies were selected. Several trials analysing the role of upfront TORS to treat early stage p16+ OPSCC and the possibility of reducing the adjuvant radiotherapy were founded. A lot of studies based on the experience of single centres show promising results. Nevertheless to date no definitive data can be extrapolated. The continued investigation of this line of de-escalation therapy with randomized prospective clinical trials is needed.
Topics: Female; Humans; Male; Neoplasm Staging; Oropharyngeal Neoplasms; Robotic Surgical Procedures
PubMed: 33341006
DOI: 10.1016/j.oraloncology.2020.105111 -
Cancer Radiotherapie : Journal de La... Oct 2022The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM... (Review)
Review
The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM classification, the current standards of management do not authorize the management of these patients to be singled out. However, their distinct oncogenesis and their excellent prognosis compared to other patients has allowed the development of several clinical trials based on the question of therapeutic de-escalation. This review of the literature aims to take stock of the elements provided by clinical research in recent years.
Topics: Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis
PubMed: 36030192
DOI: 10.1016/j.canrad.2022.06.018 -
Advances in Anatomic Pathology May 2018There has been a sharp increase in the incidence of the human papilloma virus-related oropharyngeal squamous cell carcinoma, partly due to the increasingly widespread... (Review)
Review
There has been a sharp increase in the incidence of the human papilloma virus-related oropharyngeal squamous cell carcinoma, partly due to the increasingly widespread awareness and recognition of this entity. This review assimilates the recent histopathologic classifications, staging systems, rapidly expanding research base and developments in management of human papilloma virus-related oropharyngeal squamous cell carcinoma and summarizes their implications for routine diagnostic practice. Differential diagnoses and their cytologic appearances are detailed and the utility of p16 staining and other immunohistochemistry testing is discussed.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections; Squamous Cell Carcinoma of Head and Neck
PubMed: 29394171
DOI: 10.1097/PAP.0000000000000179 -
Oral Diseases Jul 2016Narrow Band Imaging (NBI) is an endoscopic optical imaging enhancement technology that improves the contrast of mucosal surface texture, and enhances visualisation of... (Review)
Review
Narrow Band Imaging (NBI) is an endoscopic optical imaging enhancement technology that improves the contrast of mucosal surface texture, and enhances visualisation of mucosal and submucosal vasculature. White light is filtered to emit two 30-nm narrow bands of blue (415 nm) and green light (540 nm) light simultaneously, the former corresponding to the main peak absorption spectrum of haemoglobin, and the latter allowing visualisation of blood vessels in the deeper mucosal and submucosal layers. NBI has been used to better assess oral potentially malignant disorders (OPMD), identify oral and oropharyngeal squamous cell carcinoma (SCC), and to define surgical margins of head and neck malignancies. NBI shows great potential in improving detection rates of OPMD, facilitating better assessment of oral and oropharyngeal SCC, and reducing the risk of recurrence for oral SCC. Although further research is required to better understand and define intrapapillary capillary loop (IPCL) patterns and to relate these with clinical, histopathological and molecular parameters especially for early mucosal changes, there is building evidence to recommend its use as the new gold standard for endoscopic assessment in head and neck oncology.
Topics: Humans; Narrow Band Imaging; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms
PubMed: 26713751
DOI: 10.1111/odi.12430 -
The Journal of Laryngology and Otology May 2016This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. There has been significant debate...
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. There has been significant debate in the management of oropharyngeal cancer in the last decade, especially in light of the increased incidence, clarity on the role of the human papilloma virus in this disease and the treatment responsiveness of the human papilloma virus positive cancers. This paper discusses the evidence base pertaining to the management of oropharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. Recommendations • Cross-sectional imaging is required in all cases to complete assessment and staging. (R) • Magnetic resonance imaging is recommended for primary site and computed tomography scan for neck and chest. (R) • Positron emission tomography combined with computed tomography scanning is recommended for the assessment of response after chemoradiotherapy, and has a role in assessing recurrence. (R) • Examination under anaesthetic is strongly recommended, but not mandatory. (R) • Histological diagnosis is mandatory in most cases, especially for patients receiving treatment with curative intent. (R) • Oropharyngeal carcinoma histopathology reports should be prepared according to The Royal College of Pathologists Guidelines. (G) • Human papilloma virus (HPV) testing should be carried out for all oropharyngeal squamous cell carcinomas as recommended in The Royal College of Pathologists Guidelines. (R) • Human papilloma virus testing for oropharyngeal cancer should be performed within a diagnostic service where the laboratory procedures and reporting standards are quality assured. (G) • Treatment options for T1-T2 N0 oropharyngeal squamous cell carcinoma include radical radiotherapy or transoral surgery and neck dissection (with post-operative (chemo)radiotherapy if there are adverse pathological features on histological examination). (R) • Transoral surgery is preferable to open techniques and is associated with good functional outcomes in retrospective series. (R) • If treated surgically, neck dissection should include levels II-IV and possibly level I. Level IIb can be omitted if there is no disease in level IIa. (R) • If treated with radiotherapy, levels II-IV should be included, and possibly level Ib in selected cases. (R) • Altering the modalities of treatment according to HPV status is currently controversial and should be undertaken only in clinical trials. (R) • Where possible, patients should be offered the opportunity to enrol in clinical trials in the field. (G).
Topics: Chemoradiotherapy; Combined Modality Therapy; Humans; Interdisciplinary Communication; Magnetic Resonance Imaging; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis; Tomography, X-Ray Computed; United Kingdom
PubMed: 27841123
DOI: 10.1017/S0022215116000505 -
Neuroimaging Clinics of North America Feb 2013The face of oropharyngeal squamous cell carcinoma (OPSCC) is changing. It has a dichotomous nature, with 1 subset of the disease associated with tobacco and alcohol use... (Review)
Review
The face of oropharyngeal squamous cell carcinoma (OPSCC) is changing. It has a dichotomous nature, with 1 subset of the disease associated with tobacco and alcohol use and the other having proven association with human papilloma virus infection. Imaging plays an important role in the staging and surveillance of OPSCC, and a detailed knowledge of the anatomy and pitfalls is critical. This article will review the detailed anatomy of the oropharynx and epidemiology of OPSS, along with its staging, patterns of spread, and treatment.
Topics: Carcinoma, Squamous Cell; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Oropharyngeal Neoplasms; Tomography, X-Ray Computed
PubMed: 23199661
DOI: 10.1016/j.nic.2012.08.005 -
The Laryngoscope Oct 2022Investigate outcomes following oral cavity and oropharyngeal salvage surgery.
OBJECTIVES
Investigate outcomes following oral cavity and oropharyngeal salvage surgery.
METHODS
Adult patients who underwent salvage surgery for recurrent squamous cell carcinoma of the oral cavity and oropharynx from 1996 to 2018 were analyzed using multivariable Cox proportional hazards regression. Disease-free survival (DFS), overall survival (OS), associated factors, and basic quality measures were analyzed.
RESULTS
One hundred and eight patients (72% oral cavity, 28% oropharynx) were followed for a median of 17.9 months. Median DFS and OS were 9.9 and 21 months, respectively. Surgery with adjuvant chemoradiotherapy compared to surgery alone (hazard ratio [HR] = 0.15, 95% confidence interval [CI]: 0.03-0.78) and negative margins (HR = 0.36, 95% CI: 0.14-0.90) were associated with better DFS, while lymphovascular space invasion (LVSI) (HR = 2.66, 95% CI: 1.14-6.19) and higher stage (III vs. I-II, HR = 3.94, 95% CI: 1.22-12.71) were associated with worse DFS. Higher stage was associated with worse OS (HR = 3.79, 95% CI: 1.09-13.19). Patients were hospitalized for a median of 8 days with 24% readmitted within 30 days. A total of 72% and 38% of patients, respectively, underwent placement of a feeding tube or tracheostomy.
CONCLUSIONS
After oral cavity and oropharyngeal salvage surgery, adjuvant chemoradiotherapy, negative margins, negative LVSI, and lower stage were associated with a lower risk of recurrence. Only lower-stage disease was associated with improved survival. The majority of patients had feeding tubes, half underwent free tissue transfer, a third required tracheostomy, and a quarter was readmitted.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:1984-1992, 2022.
Topics: Adult; Humans; Margins of Excision; Mouth; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Retrospective Studies; Salvage Therapy
PubMed: 35191537
DOI: 10.1002/lary.30070