Advances in the Management of HPV-Related Oropharyngeal Cancer.

F De Felice,M De Vincentiis,S Mezi,A Polimeni,V Tombolini,O Brugnoletti,V Valentini

doi:10.1155/2019/9173729

Abstract

Patients with human papillomavirus- (HPV-) related oropharyngeal squamous cell carcinoma (OPSCC) have a better prognosis than HPV-negative OPSCC when treated with standard high-dose cisplatin-based chemoradiotherapy. Consistent with this assertion and due to younger age at diagnosis, novel approaches to minimize treatment sequelae while preserving survival outcomes become of paramount importance. Here, we critically reviewed the evidence-based literature supporting the deintensification strategies in HPV-related OPSCC management, including radiotherapy dose and/or volume reduction, replacement of cisplatin radiosensitising chemotherapy, and the use of transoral surgery. Undoubtedly, further researches are needed before changing the standard of care in this setting of patients.

Highlights

Despite oropharyngeal squamous cell carcinoma (OPSCC) representing only 0.9% of all cancer sites, its incidence is rapidly growing worldwide, with an estimated 173,495 new cases in 2018 [1]
HPVrelated OPSCC—based on the overexpression of the cyclindependent kinase p16—was part of a separate section. It resulted in a change of T and N categories, due to the important need to discriminate between the different stage groups compared to OPSCC associated to other causes
human papillomavirus- (HPV-)related OPSCC clinical (c) T classification no longer included a cT4b category, because 5-year overall survival was similar for patients classed as cT4a and cT4b according to

Summary

Introduction

Despite oropharyngeal squamous cell carcinoma (OPSCC) representing only 0.9% of all cancer sites, its incidence is rapidly growing worldwide, with an estimated 173,495 new cases in 2018 [1]. Patients with HPV-related OPSCC have a much better prognosis than those with tobacco/alcoholdriven disease, despite a higher stage at diagnosis due to a typical small primary in the oropharynx with massive regional nodal involvement. Compared with HPV-negative OPSCC, HPV-related OPSCC affects younger patients with a lower comorbidity index, a higher socioeconomic status, and a history of multiple sexual partners and orogenital sexual practice [5]. Intensity modulated radiation therapy with concurrent cisplatin-based chemotherapy represents the standard treatment, when appropriate. This definitive chemoradiotherapy (CRT) approach aims to eradicate tumor cells and minimize both acute and late toxicities. Given the favorable prognosis in a younger patient cohort, novel treatment regimens with the same tumor control and lower toxicity rates are a welcome change. An assessment of new staging system for HPV-related OPSCC and its development was reported

Materials and Methods

Results

Conclusions