What is the Current Evidence Base for Management of Oropharyngeal Cancer?

Abstract

This review will provide a comprehensive overview of the current management of oropharyngeal cancer. The contemporary literature, as it relates to diagnosis and management, will be summarized and the existing limitations of our knowledge will be highlighted. Research questions which need to be addressed as a matter of urgency will be listed and ongoing clinical trials designed to fill the current gaps in our knowledge will be briefly described. EPIDEMIOLOGYIn a recent UK multicenter, cross-sectional study, the human papillomavirus (HPV) status of archival tumor tissue blocks, collected from 1,602 patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) between 2002 and 2011, was determined. The overall proportion of HPV-positive OPSCC was 51.8% [95% confidence interval (CI), 49.3-54.4], and this remained unchanged throughout the decade [unadjusted risk ratio = 1.00 (95% CI, 0.99-1.02)]. In view of the doubling in incidence, it was concluded that the absolute number of both HPV-positive and HPV-negative cases in the UK was increasing. 1 These UK data contrast with published data from other parts of the world where substantial variation has been reported in the proportion of OPSCC attributable to IJHNS

Longitudinal measurement of HPV copy number in cell-free DNA is associated with patient outcomes in HPV-positive oropharyngeal cancer

“…Pre-treatment assessment of OPSCC includes determining tumour HPV status by immunohistochemistry (IHC) against the protein p16 and/or HPV PCR testing of biopsy material [7]. Treatment is determined with a multidisciplinary team (MDT) approach on an individual patient basis [8]. Early-stage disease (AJCC TNM 7th edition stage I/II) is managed with radiotherapy (RT) or surgical resection while advanced disease (AJCC TNM 7th edition stage III/ IV) is managed with combination therapy which may include surgery, radiotherapy and chemotherapy [8].…”