Overview of Advances in Head and Neck Cancer.

Abstract

The term head and neck cancer may refer exclusively to cancers arising from the upper aerodigestive tract or more broadly to any malignancy originating in the head and neck region. In this Special Series issue of Journal of Clinical Oncology, there is a major focus on squamous cell carcinomas arising from the upper aerodigestive tract mucosa. In addition, we also address nasopharyngeal cancer, nonmelanoma cutaneous head and neck cancer, and squamous carcinoma of the neck of unknown primary origin. The 16 articles in this issue provide the reader with an overview of current evidence and management, recent developments, and insights into future directions. The relatively recent recognition that human papillomavirus (HPV) is a cause of oropharyngeal cancer (OPC)— and that this is a distinct entity with different clinical and molecular features— has had a profound impact on the field. In this series, we include three articles that review our rapidly evolving understanding of HPV-related head and neck cancers. Hayes et al 1 review the molecular landscape of HPV-positive and -negative head and neck cancers after the recently published Cancer Genome Atlas analysis, 2 demonstrating significant molecular differences that may have therapeutic implications in the future. Gillison et al 3 review the epidemiology of HPV head and neck cancer and oral HPV infection, including the geographic variation in incidence and in the HPV-attributable fraction and the prospects for virus-specific cancer prevention. The overall better prognosis of HPV-associated OPC and the identification of a low-risk population with an excellent prognosis have led to concerns that our current treatments, mainly derived from trials of HPV-negative head and neck cancer, may be more intensive than is necessary. Bhatia and Burtness 4 review what is known about risk groups and describe de-escalation trials designed to maintain high cure rates with less toxicity.