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Radiographics : a Review Publication of... 2011The imaging findings in squamous cell carcinoma (SCC) of the oral cavity and oropharynx vary widely, depending on the site of origin of the primary tumor and the extent... (Review)
Review
The imaging findings in squamous cell carcinoma (SCC) of the oral cavity and oropharynx vary widely, depending on the site of origin of the primary tumor and the extent of its involvement of other regions. Knowledge of the complex anatomy of the oral cavity and oropharynx, as well as the most common routes by which SCC spreads from various anatomic sites, allows the radiologist to accurately determine the extent of disease and help clinicians plan appropriate treatment. SCCs that originate in the oral cavity tend to behave differently than those that originate in the oropharynx, with the latter group exhibiting more aggressive growth. Furthermore, primary tumors in certain anatomic subsites within the oral cavity or oropharynx have a greater propensity to spread by direct extension along muscle, bone, or neurovascular bundles or to be disseminated along lymphatic drainage pathways to regional or distant nodes. Imaging findings of deep muscular, neurovascular, osseous, or nodal involvement are indicative of an advanced stage of disease for which management options are limited.
Topics: Carcinoma, Squamous Cell; Humans; Mouth Neoplasms; Neoplasm Staging; Oropharyngeal Neoplasms; Prognosis; Tomography, X-Ray Computed
PubMed: 21415183
DOI: 10.1148/rg.312105107 -
Scientific Reports Jul 2021To improve risk prediction for oropharyngeal cancer (OPC) patients using cluster analysis on the radiomic features extracted from pre-treatment Computed Tomography (CT)...
To improve risk prediction for oropharyngeal cancer (OPC) patients using cluster analysis on the radiomic features extracted from pre-treatment Computed Tomography (CT) scans. 553 OPC Patients randomly split into training (80%) and validation (20%), were classified into 2 or 3 risk groups by applying hierarchical clustering over the co-occurrence matrix obtained from a random survival forest (RSF) trained over 301 radiomic features. The cluster label was included together with other clinical data to train an ensemble model using five predictive models (Cox, random forest, RSF, logistic regression, and logistic-elastic net). Ensemble performance was evaluated over the independent test set for both recurrence free survival (RFS) and overall survival (OS). The Kaplan-Meier curves for OS stratified by cluster label show significant differences for both training and testing (p val < 0.0001). When compared to the models trained using clinical data only, the inclusion of the cluster label improves AUC test performance from .62 to .79 and from .66 to .80 for OS and RFS, respectively. The extraction of a single feature, namely a cluster label, to represent the high-dimensional radiomic feature space reduces the dimensionality and sparsity of the data. Moreover, inclusion of the cluster label improves model performance compared to clinical data only and offers comparable performance to the models including raw radiomic features.
Topics: Aged; Algorithms; Area Under Curve; Cluster Analysis; Computational Biology; Diagnostic Imaging; Female; Humans; Image Processing, Computer-Assisted; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Prognosis; Software
PubMed: 34234160
DOI: 10.1038/s41598-021-92072-8 -
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 -
Otolaryngology--head and Neck Surgery :... Jun 2016The incidence of oropharyngeal squamous cell carcinoma (SCCa) has increased in the United States despite a decrease in tobacco usage, and it may be driven by an increase...
OBJECTIVE
The incidence of oropharyngeal squamous cell carcinoma (SCCa) has increased in the United States despite a decrease in tobacco usage, and it may be driven by an increase in oral human papilloma virus (HPV) infection. We studied the incidence of tongue base and tonsillar SCCa over time to understand the changing epidemiology of oropharyngeal SCCa.
SETTING
Large national tumor registry.
SUBJECTS AND METHODS
We studied patients diagnosed with oropharyngeal SCCa in SEER data (Surveillance, Epidemiology, and End Results) from 1973 to 2009. Age-adjusted incidence rates standardized to the 2000 US population were computed, with stratifications for age, sex, race, and stage.
RESULTS
The sample included 10,061 tongue base and 11,515 tonsillar oropharyngeal cancers. When stratified by age, the incidence of oropharyngeal SCCa in patients ≤55 years of age more than doubled over 30 years. While the incidence rate in females remained stable, the rate in males more than doubled, from 2 per 100,000 persons in 1973 to >4 per 100,000 persons in 2009. The age-adjusted incidence of oropharyngeal SCCa in patients of black race/ethnicity remained consistently elevated, but the incidence in patients of white race/ethnicity rose from 1.3 per 100,000 persons to >2.5 per 100,000 persons, surpassing the incidence in black patients starting in 2002.
CONCLUSION
The observation that the incidence of oropharyngeal SCCa is increasing among younger white males, despite a reduction in tobacco usage in the United States, is consistent with HPV as the source. Primary and secondary prevention strategies may be warranted in this population.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Incidence; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections; Registries; SEER Program; United States
PubMed: 26932972
DOI: 10.1177/0194599816633690 -
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 -
Brazilian Journal of Otorhinolaryngology 2023According to an extensive database, the Objective is to compare surgical versus non-surgical treatment through Propensity Score (PS) for patients with Oropharyngeal...
UNLABELLED
According to an extensive database, the Objective is to compare surgical versus non-surgical treatment through Propensity Score (PS) for patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC).
METHODS
We retrospectively evaluated epidemiological data from 8075 patients with OPSCC diagnosed between 2004 and 2014 and used PS matching to analyze possible prognostic factors for its outcomes with regression analyses.
RESULTS
Cox multiple regression analysis to study survival after PS matching shows that type of treatment was associated with death with a hazard ratio of 1.753 (p<0.05) of non-surgical treatment. However, it was not associated with recurrence (p>0.05). In the surgical treatment group, overall survival was 79.9% at one year, 36.4% at five years, and 20.5% at ten years. Disease-free survival was 90.1%, 64.8%, and 56.0% at 1, 5, and 10-years, respectively. In the non-surgical treatment group, overall survival was 60.6% at one year, 21.8% at five years, and 12.7% at ten years. Disease-free survival was 90.8%, 67.2%, and 57.8% at 1, 5, and 10-years, respectively.
CONCLUSION
Patients in the surgical treatment group had better outcomes related to survival. Recurrence is associated with the survival of OPSCC cancer. Recurrence-free survival is similar to both treatments.
LEVEL OF EVIDENCE
2C.
Topics: Humans; Propensity Score; Male; Retrospective Studies; Female; Oropharyngeal Neoplasms; Middle Aged; Carcinoma, Squamous Cell; Treatment Outcome; Aged; Disease-Free Survival; Neoplasm Recurrence, Local; Adult; Neoplasm Staging; Prognosis
PubMed: 37813007
DOI: 10.1016/j.bjorl.2023.101335 -
Oral Oncology Feb 2021HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) carries a favorable prognosis for patients, yet nearly 30% of patients will experience disease relapse. We...
PURPOSE
HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) carries a favorable prognosis for patients, yet nearly 30% of patients will experience disease relapse. We sought to detail patterns of failure, associated salvage therapy, and outcomes for patients with recurrent HPV-positive OPSCC.
METHODS AND MATERIALS
This is a single institution retrospective study of patients with recurrent HPV-positive OPSCC irradiated from 2002 to 2014. The primary study outcome was overall survival (OS, calculated using the Kaplan-Meier method). Secondary aims included patterns of first failure with descriptive details of salvage therapy. Solitary recurrences were defined as initial presentation of recurrence in a single site (primary, neck or oligometastatic), and multi-site was defined as local and regional and/or multiple sites of distant recurrence. Survival outcomes were compared using the log-rank test.
RESULTS
The cohort consisted of 132 patients. The median follow-up was 59 months for surviving patients. Estimated 2-year and 5-year OS rates were 47% and 32%, respectively. Comparative 2-year and 5-year OS rates were 65% and 46% versus 19% and 9% for the solitary group and multi-site group, respectively (p < .001).
CONCLUSIONS
Patients with recurrent HPV-positive OPSCC experience 5-year survival of approximately 32%. However, patients with a "solitary" recurrence including disease at the primary site, neck or oligometastatic site have more favorable long-term outcomes.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis; Salvage Therapy; Survival Analysis; Treatment Outcome
PubMed: 33360375
DOI: 10.1016/j.oraloncology.2020.105125 -
Current Treatment Options in Oncology Jun 2016Given the potential for long-term toxicities from concurrent chemoradiation, there is great interest in surgery as a primary treatment modality for head and neck... (Review)
Review
Given the potential for long-term toxicities from concurrent chemoradiation, there is great interest in surgery as a primary treatment modality for head and neck cancers, particularly in the younger HPV-positive oropharyngeal cancer patient. Transoral robotic surgery (TORS) has proven to be an effective technique to safely treat oropharyngeal and select supraglottic tumors surgically. Sound, traditional surgical principles are employed using improved endoscopic visualization and precise instrumentation to perform oncologic surgery without the morbidity of transmandibular or transcervical approaches. Although level 1 evidence prospective clinical trials are currently underway for TORS, the literature supports its safety and efficacy based on numerous studies. Currently, prospective randomized trials are underway to provide better evidence for or against TORS in oropharyngeal cancer. Patient selection based on comorbidities, anatomy, and available pathological data is critical in choosing patients for TORS.
Topics: Clinical Trials as Topic; Head and Neck Neoplasms; Humans; Minimally Invasive Surgical Procedures; Neoplasm Staging; Oropharyngeal Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 27117980
DOI: 10.1007/s11864-016-0405-5 -
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 -
European Journal of Surgical Oncology :... Sep 2023Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse...
OBJECTIVES
Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse oncological outcomes of OPSCC patients treated with TORS.
MATERIALS AND METHODS
This study involved 139 patients with OPSCC, treated with TORS between 2008 and 2020. Clinicopathological characteristics, treatment details and oncological outcomes were evaluated retrospectively.
RESULTS
The management strategies included TORS alone in 42.5%, TORS-RT in 25.2% and TORS-CRT in 30.9%. The ENE was noted in 28.8% of neck dissections. In 19 patients clinically classified as unknown primaries, the primary was found in 73.7%. Rates of local, regional relapses and distant metastasis were 8.6%, 7.2%, and 6.5%, respectively. The 5 year- Overall Survival and Disease Free Survival were 69.6% and 71.3%, respectively.
CONCLUSION
TORS fits well in the modern management of OPSCC. Although definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of the therapeutic strategy requires evaluation by a multidisciplinary team.
Topics: Humans; Retrospective Studies; Robotic Surgical Procedures; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms
PubMed: 37331862
DOI: 10.1016/j.ejso.2023.05.020