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Head and Neck Pathology Jul 2012Imaging, especially contrast-enhanced computed tomography (CECT) for anatomy and positron emission tomography (PET) with labeled (18)F fluorodeoxyglucose for physiologic... (Review)
Review
Imaging, especially contrast-enhanced computed tomography (CECT) for anatomy and positron emission tomography (PET) with labeled (18)F fluorodeoxyglucose for physiologic detail, is critical for staging carcinomas of the oropharynx. As the incidence of human papillomavirus (HPV) infection and related carcinomas of the tonsil and base of tongue (BOT) increases, experience with CECT and PET for staging HPV+ tumors is growing. No imaging modality, however, can determine whether the tumor is HPV+. There are some unique challenges posed by HPV+ oropharyngeal squamous cell carcinoma (SCC). In most locations of the head and neck, a malignancy enhances more than surrounding normal structures, which facilitates tumor mapping. Unfortunately, normal lymphoid tissue of the oropharynx, in the BOT and palatine tonsillar fossa, enhances on CECT and gadolinium enhanced magnetic resonance imaging in a manner similar to SCC. The primary tumor may be small or even occult at presentation, and easily over-looked on CECT. PET coupled with CECT has made a true "unknown primary" very rare, as the metabolically active tumor is almost always detectable on PET. The nodal metastases, so common with HPV+ SCC, can be truly cystic; and as such, can be misdiagnosed as a second branchial cleft cyst, a congenital benign lesion. These pitfalls, coupled with the complex anatomy of the upper aerodigestive tract, make staging these tumors difficult. In this monograph we describe the anatomy of the oropharynx and review the imaging modalities available for staging. Figures highlight the points raised in the text.
Topics: Carcinoma, Squamous Cell; Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 22782221
DOI: 10.1007/s12105-012-0374-3 -
Medicine May 2019This study used radiomics image analysis to examine the differences of texture feature values extracted from oropharyngeal and hypopharyngeal cancer positron emission... (Observational Study)
Observational Study
This study used radiomics image analysis to examine the differences of texture feature values extracted from oropharyngeal and hypopharyngeal cancer positron emission tomography (PET) images on various tumor segmentations, and finds the proper and stable feature groups. A total of 80 oropharyngeal and hypopharyngeal cancer cases were retrospectively recruited. Radiomics method was applied to the PET image for the 80 oropharyngeal and hypopharyngeal cancer cases to extract texture features from various defined metabolic volumes. Kruskal-Wallis one-way analysis of variance method was used to test whether feature value difference exists between groups, which were grouped by stage, response to treatment, and recurrence. If there was a significant difference, the corresponding feature cutoff value was applied to the Kaplan-Meier estimator to estimate the survival functions. For the various defined metabolic volumes, there were 16 features that had significant differences between early (T1, T2) and late tumor stages (T3, T4). Five images and 2 textural features were found to be able to predict the tumor response and recurrence, respectively, with the areas under the receiver operating characteristic curves reaching 0.7. The histogram entropy was found to be a good predictor of overall survival (OS) and primary relapse-free survival (PRFS) of oropharyngeal and hypopharyngeal cancer patients. Textural features from PET images provide predictive and prognostic information in tumor staging, tumor response, recurrence, and have the potential to be a prognosticator for OS and PRFS in oropharyngeal and hypopharyngeal cancer.
Topics: Adult; Aged; Female; Humans; Hypopharyngeal Neoplasms; Image Processing, Computer-Assisted; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Positron Emission Tomography Computed Tomography; Prognosis; ROC Curve; Retrospective Studies
PubMed: 31045814
DOI: 10.1097/MD.0000000000015446 -
Journal of Cancer Research and... 2014Squamous cell carcinoma involving the oral cavity (OC) and oropharynx regions are a major cause of morbidity and mortality world-wide. The recent discovery of a strong... (Review)
Review
Squamous cell carcinoma involving the oral cavity (OC) and oropharynx regions are a major cause of morbidity and mortality world-wide. The recent discovery of a strong association between human papilloma virus (HPV) infection and OC and oropharyngeal (OP) cancer has prompted world-wide research into the exact etiology and pathogenesis of these cancers in relation to the HPV. HPV-positive OC/OP cancers generally present at a relatively advanced stage (by virtue of cervical nodal involvement) and are more commonly seen in younger patients without significant exposure to alcohol or tobacco. These factors are implicated in prognosis, regardless of HPV association. In this article, we review the biology and epidemiology, risk factors, association, molecular analyses, treatment response and prognosis of HPV-related cancers. Role of HPV vaccination in HPV-related OC/OP cancers has also been discussed.
Topics: Alphapapillomavirus; Humans; Mouth Neoplasms; Oropharyngeal Neoplasms; Papillomavirus Infections; Risk Factors; Treatment Outcome; Tumor Virus Infections
PubMed: 25313727
DOI: 10.4103/0973-1482.138213 -
Head & Neck Dec 2021Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck...
BACKGROUND
Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck cancer.
METHODS
In a consecutive cohort of 521 patients with oropharyngeal squamous cell carcinoma (OPSCC), we investigated the impact of rTBs and prolongation of overall treatment time (OTT) on OS, DFS, LRC, and cancer recurrence using competing risk and multivariate analyses.
RESULTS
Neither OTT prolongation by ≤2 days nor rTBs of ≤3 days were associated with detriments to clinical outcomes. Consecutive breaks of ≥3 days were also not significantly associated with detriment to clinical outcomes. There was significantly increased competing mortality in those with longer breaks.
CONCLUSIONS
In OPSCC patients treated with definitive concurrent chemoradiotherapy, there is no significant association between disease failure and total rTBs of ≤3 consecutive or scattered days. Further investigation is needed for longer breaks.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy; Head and Neck Neoplasms; Humans; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Retrospective Studies
PubMed: 34585792
DOI: 10.1002/hed.26879 -
Scientific Reports Jan 2020Pathological staging and histological grading systems are useful, but imperfect, predictors of recurrence in head and neck squamous cell carcinoma (HNSCC). Aberrant...
Pathological staging and histological grading systems are useful, but imperfect, predictors of recurrence in head and neck squamous cell carcinoma (HNSCC). Aberrant promoter methylation is the main type of epigenetic modification that plays a role in the inactivation of tumor suppressor genes. To identify new potential prognostic markers, we investigated the promoter methylation status of five neuropeptide receptor genes. The methylation status of the target genes was compared with clinical characteristics in 278 cases; 72 hypopharyngeal cancers, 54 laryngeal cancers, 75 oropharyngeal cancers, and 77 oral cavity cancers were studied. We found that the NTSR1, NTSR2, GHSR, MLNR, and NMUR1 promoters were methylated in 47.8%, 46.8%, 54.3%, 39.2%, and 43.5% of the samples, respectively. GHSR and NMUR1 promoter methylation independently predicted recurrence in HNSCC. In patients with oropharyngeal cancer (n = 75), GHSR and NMUR1 promoter methylation significantly correlates with survival in surgically treated patients. We classified our patients as having a low, intermediate, or high-risk of death based on three factors: HPV status, and GHSR and NMUR1 promoter methylation. The disease-free survival (DFS) rates were 87.1%, 42.7%, and 17.0%, respectively. Combined data analysis of the methylation status of ten-eleven translocation (TET) family genes indicated a trend toward greater methylation indices as the number of TET methylation events increased. In the current study, we presented the relationship between the methylation status of the GHSR and NMUR1 genes and recurrence in HNSCC, specifically in risk classification of oropharyngeal carcinomas cases with HPV status.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; DNA Methylation; DNA-Binding Proteins; Dioxygenases; Disease-Free Survival; Female; Humans; Male; Middle Aged; Mixed Function Oxygenases; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Promoter Regions, Genetic; Proto-Oncogene Proteins; Receptors, Ghrelin; Receptors, Neurotransmitter; Squamous Cell Carcinoma of Head and Neck
PubMed: 31974445
DOI: 10.1038/s41598-020-57920-z -
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 -
Human Vaccines & Immunotherapeutics 2014Listeria monocytogenes is a bacterium that can be genetically modified to express fusion proteins with antigens specific to certain cancer models. This technology has... (Review)
Review
Listeria monocytogenes is a bacterium that can be genetically modified to express fusion proteins with antigens specific to certain cancer models. This technology has been harnessed to develop ADXS11-001, a vaccine that aims to elicit an immune response against human papillomavirus (HPV) oncoprotein E7. Pre-clinical studies assessing the efficacy of recombinant Listeria vaccination targeting this same oncoprotein have consistently demonstrated successful reduction of in vivo tumor burden among animal cancer models. Several clinical trials are underway to assess the efficacy of ADXS11-001 in eliciting both immune and clinical responses against HPV-related human cervical, oropharyngeal and anal cancers.
Topics: Antigens, Neoplasm; Anus Neoplasms; Cancer Vaccines; Female; Humans; Listeria monocytogenes; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus E7 Proteins; Papillomavirus Infections; Recombinant Fusion Proteins; Uterine Cervical Neoplasms
PubMed: 25483687
DOI: 10.4161/hv.34378 -
European Annals of Otorhinolaryngology,... Apr 2017To analyze postoperative course, oncologic and functional results and prognostic factors of transoral-transcervical oropharyngeal cancer surgery without mandibulotomy,...
Transoral-transcervical oropharyngectomy without mandibulotomy, associated to fasciocutaneous radial forearm free-flap reconstruction, for oropharyngeal cancer: Postoperative course, oncologic and functional results, and prognostic factors.
OBJECTIVE
To analyze postoperative course, oncologic and functional results and prognostic factors of transoral-transcervical oropharyngeal cancer surgery without mandibulotomy, associated to radial forearm free-flap reconstruction.
MATERIAL AND METHODS
Retrospective analysis of computerized medical records of all patients who underwent this type of surgery in our institution between 2004 and 2014. Predictive factors of oncologic and functional results were investigated on univariate and multivariate analyses.
RESULTS
Forty-four patients (37 male, 7 female; mean age, 62.3±9.3years) were included. Three-year overall, disease-specific and recurrence-free survival was 90%, 92% and 79%, respectively. Functional scores were satisfactory (normal or slight impairment) for feeding, speech and oral opening functions in 86%, 93% and 100% of cases, respectively. ASA score≥III had significantly negative impact on overall survival (P=0.005) and on feeding (P=0.01) and speech (P=0.01).
CONCLUSION
Transoral-transcervical oropharyngeal cancer surgery without mandibulotomy provided excellent oncologic and functional outcomes; it is an advantageous alternative to the conventional conservative transmandibular oropharyngectomy.
Topics: Aged; Carcinoma, Squamous Cell; Electronic Health Records; Female; Follow-Up Studies; Free Tissue Flaps; Humans; Kaplan-Meier Estimate; Male; Mandibular Osteotomy; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Pharyngectomy; Prognosis; Radius; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 27914910
DOI: 10.1016/j.anorl.2016.11.004 -
JAMA Network Open Jun 2021Definitive chemoradiotherapy and upfront surgical treatment are both accepted as the standard of care for advanced-stage oropharyngeal squamous cell carcinoma. However,...
IMPORTANCE
Definitive chemoradiotherapy and upfront surgical treatment are both accepted as the standard of care for advanced-stage oropharyngeal squamous cell carcinoma. However, the optimal primary treatment modality remains unclear.
OBJECTIVE
To evaluate the comparative effectiveness of definitive chemoradiotherapy and upfront surgical treatment for advanced-stage oropharyngeal cancer.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective comparative effectiveness analysis used data from the population-based Taiwan Cancer Registry. Included patients were diagnosed with clinical stage III or IV oropharyngeal squamous cell carcinoma from 2007 to 2015 and were identified from the registry. Patients with T4b or N3 disease were excluded. Data were analyzed from June 2019 through December 2020.
INTERVENTIONS
Definitive chemoradiotherapy or upfront surgical treatment.
MAIN OUTCOMES AND MEASURES
The primary outcome was overall survival, for which data were available through December 31, 2018. Secondary outcomes were progression-free survival, locoregional recurrence-free survival, and distant metastasis-free survival.
RESULTS
Among 1180 patients, 694 patients (58.8%) were in the definitive chemoradiotherapy group and 486 patients (41.2%) were in the upfront surgical treatment group. The median (interquartile range) follow-up was 3.62 (1.63-5.47) years, and most patients were men (1052 [89.1%] men) with a primary tumor in the tonsils (712 patients [60.3%]), moderately differentiated histology (604 patients [51.2%]), clinical N2 disease (858 patients [72.7%]), and clinical stage IVA disease (938 patients [79.5%]). The mean (SD) age was 54.59 (10.35) years. Primary treatment with an upfront surgical procedure was associated with a decreased risk of death during the study period (hazard ratio [HR], 0.81; 95% CI, 0.69-0.97; P = .02). However, when adjusted for age, subsite, histological grade, and T and N classification, upfront surgical treatment was no longer associated with an increased risk of death during the study period (HR, 0.96; 95% CI, 0.80-1.16; P = .70). Progression-free survival was worse in the group receiving upfront surgical treatment than in the group receiving chemoradiotherapy (HR, 1.64; 95% CI, 1.09-2.46; P = .02), and this difference persisted after adjusting for other factors associated with prognosis (ie, age, tumor subsite, histological grade, and T and N classification) (HR, 1.72; 95% CI, 1.12-2.66; P = .01).
CONCLUSIONS AND RELEVANCE
This study found that definitive chemoradiotherapy was associated with effectiveness that was comparable with that of upfront surgical treatment when adjusted for baseline factors associated with prognosis. These findings suggest that definitive chemoradiotherapy should be considered to avoid accumulating toxic effects associated with surgical treatment and chemoradiotherapy.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy; Chemotherapy, Adjuvant; Female; Humans; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Prognosis; Risk Factors; Taiwan; Treatment Outcome
PubMed: 34061201
DOI: 10.1001/jamanetworkopen.2021.12067 -
Biomedical Papers of the Medical... Dec 2023HPV16 status in oropharyngeal cancer (OPC) is an important prognostic factor. Its determination, based on immunistochemical analysis of p16 oncoprotein requires an... (Review)
Review
HPV16 status in oropharyngeal cancer (OPC) is an important prognostic factor. Its determination, based on immunistochemical analysis of p16 oncoprotein requires an invasive biopsy. Thus, alternative methods are being sought. Determining oral HPV16 status appears to be a promising alternative. However, it is not used routinely. This prompted us to perform a systematic literature review enabling us to evaluate the diagnostic and predictive ability of this approach. Thirty-four relevant studies were finally selected. For determination of HPV status in OPC, the calculated average sensitivity and specificity for oral sampling was 74% and 91%, respectively, with p16 tumour tissue marker being the gold standard. The method appears to be valuable in monitoring treatment response as well as the biological activity of the tumour, enabling early detection of persistent or relapsing carcinoma sufficiently long before its clinical and/or radiological manifestation. It can also contribute to identification of the primary tumour in cases of metastases of unknown origin. Last but not least, the screening HPV oral testing would help to identify individuals with persistent HPV oral infection who are at increased risk of development of OPC.
Topics: Humans; Papillomavirus Infections; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Carcinoma; Sensitivity and Specificity; Biomarkers, Tumor
PubMed: 37901925
DOI: 10.5507/bp.2023.040