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Amato M, Santonocito S, Bruno MT, Polizzi A, Mastroianni A, Chaurasia A, Isola G. Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors. Heliyon 2024; 10:e31061. [PMID: 38813162 PMCID: PMC11133762 DOI: 10.1016/j.heliyon.2024.e31061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/11/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
Human Papilloma Virus (HPV) is considered one of the most common sexually transmitted infections and has been shown to play an important role in the pathogenesis of squamous cell carcinomas (SCC) of the cervix and head and neck. Manifestations of HPV infections can be manifold, ranging from asymptomatic infections to benign or potentially malignant lesions to intraepithelial neoplasms and invasive carcinomas. The heterogeneity of clinical manifestations from HPV infection depends on the interactions between the viral agent and the host, a direct consequence of the ability on the part of HPV is to remain silent and to evade and convey the action of the host immune system. The oral mucosa represents one of the tissues for which HPV has a distinct tropism and is frequently affected by infection. While much information is available on the role that HPV infection plays in the development of SCC in the oral cavity, there is less information on asymptomatic infections and benign HPV-induced oral lesions. Therefore, the purpose of this review is to analyze, in light of current knowledge, the early clinical and bio-humoral prognostic features related to the risk of HPV malignant transformation, focusing on subclinical conditions, benign lesions, and the correlation between oral infection and infection in other districts. The data show that the main risk associated with HPV infection is related to malignant transformation of lesions. Although HPV-driven OPSCC is associated with a better prognosis than non-HPV-driven OPSCC, primary prevention and early detection of the infection and affected genotype are essential to reduce the risk of malignant neoplastic complications and improve the prognosis.
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Affiliation(s)
- Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Maria Teresa Bruno
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Mastroianni
- Dentistry Unit, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Akhilanand Chaurasia
- Department of Oral Medicine & Radiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
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Caldarella C, De Risi M, Massaccesi M, Miccichè F, Bussu F, Galli J, Rufini V, Leccisotti L. Role of 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications. Cancers (Basel) 2024; 16:1905. [PMID: 38791983 PMCID: PMC11119768 DOI: 10.3390/cancers16101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
This article provides an overview of the use of 18F-FDG PET/CT in various clinical scenarios of head-neck squamous cell carcinoma, ranging from initial staging to treatment-response assessment, and post-therapy follow-up, with a focus on the current evidence, debated issues, and innovative applications. Methodological aspects and the most frequent pitfalls in head-neck imaging interpretation are described. In the initial work-up, 18F-FDG PET/CT is recommended in patients with metastatic cervical lymphadenectomy and occult primary tumor; moreover, it is a well-established imaging tool for detecting cervical nodal involvement, distant metastases, and synchronous primary tumors. Various 18F-FDG pre-treatment parameters show prognostic value in terms of disease progression and overall survival. In this scenario, an emerging role is played by radiomics and machine learning. For radiation-treatment planning, 18F-FDG PET/CT provides an accurate delineation of target volumes and treatment adaptation. Due to its high negative predictive value, 18F-FDG PET/CT, performed at least 12 weeks after the completion of chemoradiotherapy, can prevent unnecessary neck dissections. In addition to radiomics and machine learning, emerging applications include PET/MRI, which combines the high soft-tissue contrast of MRI with the metabolic information of PET, and the use of PET radiopharmaceuticals other than 18F-FDG, which can answer specific clinical needs.
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Affiliation(s)
- Carmelo Caldarella
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Marina De Risi
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Mariangela Massaccesi
- Radiation Oncology Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Miccichè
- Radiation Oncology Unit, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy;
| | - Francesco Bussu
- Otorhinolaryngology Operative Unit, Azienda Ospedaliero Universitaria Sassari, 07100 Sassari, Italy;
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Jacopo Galli
- Otorhinolaryngology Unit, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Section of Otolaryngology, Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucia Leccisotti
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Lu D, Zhou X, Sun H, Zeng B, Fu J, Gong J, Liao G, Liang Y, Yang L. Risk of second primary cancer in patients with head and neck squamous cell carcinoma: a systemic review and meta-analysis. Clin Oral Investig 2023; 27:4897-4910. [PMID: 37540282 DOI: 10.1007/s00784-023-05066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/07/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Second primary cancer is a common event in patients with head and neck squamous cell carcinoma. However, the incidence and relevant factors vary by studies. We conducted a systematic review and meta-analysis of observational studies to estimate the incidence and relevant risk factors. MATERIALS AND METHODS PubMed and Web of Science were searched for studies published between January 2000 and December 2020 that reported the incidence of SPC in HNSCC patients. Per 1000-person-year incidence and odds ratios were used to estimate the incidence and potential risk factors. Due to the high heterogeneity, random-effects models were used to estimate the incidence and 95% confidence interval. RESULTS Seven thousand seven hundred thirteen articles were identified from the databases, in which 60 studies were included in this meta-analysis. The pooled incidence of the total, synchronous, and metachronous SPC in patients with HNSCC were 29.116 per 1000-person-year, 6.960 per 1000-person-year, and 26.025 per 1000-person-year, respectively. The head and neck region was the most common area where SPC occurred, followed by the lung (7.472 per 1000-person-year) and upper digestive tract (2.696 per 1000-person-year). Smoking, alcohol consumption, betel quid chewing, primary cancer of T1-2, and N0 were risk factors, while HPV infection (OR 0.47, 95% CI 0.30-0.72) was the protective factor. CONCLUSIONS SPC is frequently observed in HNSCC patients and had great impact on the prognosis. The findings could promote a more individualized follow-up strategy for SPC in HNSCC patients. CLINICAL RELEVANCE This systemic review and meta-analysis provide sufficient evidence for the establishment of the follow-up strategy for head and neck squamous cancer patients.
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Affiliation(s)
- Dongheng Lu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Xinyu Zhou
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No 639, Zhizaoju Rd, Shanghai, 200011, China
| | - Huaxiu Sun
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Bin Zeng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Jiarun Fu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Jianbin Gong
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Yujie Liang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China.
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China.
| | - Le Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China.
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China.
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Ershadifar S, Ustrell S, Darrow MA, Birkeland A. Synchronous Undetected HPV+ Cancer in a HPV- Tongue Cancer Patient. EAR, NOSE & THROAT JOURNAL 2023; 102:8S-11S. [PMID: 37159392 DOI: 10.1177/01455613231173456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
We report a case of a 63-year-old male who presented with synchronous pT1N1 p16-positive squamous cell carcinoma (SCC) of the left tonsil and pT4N0 p16-negative SCC of the left tongue.
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Affiliation(s)
- Soroush Ershadifar
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, CA, USA
| | - Sarah Ustrell
- Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
- St. George's University School of Medicine, St George's, WI, Grenada
| | - Morgan Angus Darrow
- Department of Pathology and Laboratory Medicine, University of California-Davis Medical Center, Sacramento, CA, USA
| | - Andrew Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, CA, USA
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Saba NF, Pamulapati S, Patel B, Mody M, Strojan P, Takes R, Mäkitie AA, Cohen O, Pace-Asciak P, Vermorken JB, Bradford C, Forastiere A, Teng Y, Wieland A, Ferlito A. Novel Immunotherapeutic Approaches to Treating HPV-Related Head and Neck Cancer. Cancers (Basel) 2023; 15:1959. [PMID: 37046621 PMCID: PMC10092986 DOI: 10.3390/cancers15071959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Head and neck cancer (HNC) is the seventh most common malignancy, with oropharyngeal squamous cell carcinoma (OPSCC) accounting for a majority of cases in the western world. While HNC accounts for only 5% of all cancers in the United States, the incidence of a subset of OPSCC caused by human papillomavirus (HPV) is increasing rapidly. The treatment for OPSCC is multifaceted, with a recently emerging focus on immunotherapeutic approaches. With the increased incidence of HPV-related OPSCC and the approval of immunotherapy in the management of recurrent and metastatic HNC, there has been rising interest in exploring the role of immunotherapy in the treatment of HPV-related OPSCC specifically. The immune microenvironment in HPV-related disease is distinct from that in HPV-negative OPSCC, which has prompted further research into various immunotherapeutics. This review focuses on HPV-related OPSCC, its immune characteristics, and current challenges and future opportunities for immunotherapeutic applications in this virus-driven cancer.
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Affiliation(s)
- Nabil F. Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | | | - Bhamini Patel
- Department of Internal Medicine, Emory University, Atlanta, GA 30307, USA
| | - Mayur Mody
- Hematology and Oncology Program, AdventHealth Medical Group, Calhoun, GA 30701, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Robert Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, 6525 Nijmegen, The Netherlands
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Research Program in Systems Oncology, FI-00014 Helsinki, Finland
| | - Oded Cohen
- Department of Otolaryngology, Ben Gurion University of the Negev, Soroka Medical Center, Be’er Sheva 84-101, Israel
| | - Pia Pace-Asciak
- Department of Otolarynology—Head and Neck Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Jan B. Vermorken
- Department of Medical Oncology, Antwerp University Hospital, 2650 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Carol Bradford
- Department of Otolaryngology, The Ohio State University, Columbus, OH 43212, USA
| | - Arlene Forastiere
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Andreas Wieland
- Department of Otolaryngology, The Ohio State University, Columbus, OH 43212, USA
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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Guarda V, Schroeder L, Pawlita M, Ikenberg K, Rupp NJ, Jochum W, Stoeckli SJ, Holzinger D, Broglie MA. Prevalence of Transcriptionally Active HPV Infection in Tumor-Free Oropharyngeal Tissue of OPSCC-Patients. Front Oncol 2022; 12:835814. [PMID: 35530340 PMCID: PMC9074725 DOI: 10.3389/fonc.2022.835814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe natural history of HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is still largely unknown. Since reports of second primary tumors (SPTs) in patients with HPV-related OPSCCs are increasing, a multifocal HPV infection, hinting a «virus-induced field effect», has been hypothesized. This study aimed to investigate the HPV-prevalence in normal appearing oropharyngeal tissue in patients with OPSCCs.Materials and Methods49 OPSCC patients undergoing panendoscopy were prospectively enrolled. Tumor specimens and biopsies of normal appearing oropharyngeal tissue adjacent to and distant from the index OPSCC underwent histopathological examination, p16INK4A immunohistochemical staining, HPV DNA and mRNA-detection. Patient characteristics and follow-up data on SPTs were obtained.Results26 of 49 (53%) OPSCC were positive for HPV DNA and p16INK4A. HPV mRNA was detected in 23 of 26 (88%) of these tumor samples. HPV DNA was detected in 36% adjacent mucosa and in 17% distant mucosa samples and only in patients with an HPV-related index OPSCC. HPV mRNA could not be detected in tumor-free distant and adjacent mucosa samples. No evidence of association between HPV detection in normal appearing mucosa and development of second primary tumors was found.ConclusionsHPV was detectable but not transcriptionally active in adjacent/distant tumor-free oropharyngeal tissue. This suggests that a multifocal HPV infection, hinting a «virus-induced fielcd cancerization», may not be pertaining to HPV-related OPSCC.
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Affiliation(s)
- Vittoria Guarda
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Vittoria Guarda,
| | - Lea Schroeder
- Infections and Cancer Epidemiology, Infection Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Infections and Cancer Epidemiology, Infection Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristian Ikenberg
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Dana Holzinger
- Infections and Cancer Epidemiology, Infection Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
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Stepan K, Craig E, Skillington SA, Deutsch BC, Chen S, Wamkpah NS, Bollig CA, Kallogjeri D, Thorstad WL, Puram SV, Pipkorn P, Jackson RS. Development of second primary malignancies after transoral surgery in human papilloma virus-positive oropharyngeal squamous cell carcinoma. Head Neck 2022; 44:1069-1078. [PMID: 35175648 PMCID: PMC9112335 DOI: 10.1002/hed.27002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/08/2021] [Accepted: 02/01/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Little data exists regarding the incidence of oropharyngeal and upper aerodigestive tract (UADT) second primary malignancies (SPM) among human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Here we evaluate SPM rates among patients with HPV-related OPSCC. METHODS A retrospective cohort study of 412 patients with HPV-related OPSCC who underwent transoral resection +/- adjuvant therapy at a single center between 1996 and 2018. RESULTS Twenty patients (4.9%) developed SPM of the UADT, nine (2.2%) occurring in the oropharynx. Median time to diagnosis was 59.5 months (0-173 months). Risk of SPM was lower for patients receiving adjuvant radiation (aHR: 0.25, 95%CI: 0.08-0.78). There was no difference in overall or disease-free survival between those with and without SPM. CONCLUSION The rate of SPM among patients with HPV-positive OPSCC is lower than reported rates among HPV-negative OPSCC. To date, this is the largest study evaluating SPM in patients with surgically treated HPV-positive OPSCC.
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Affiliation(s)
- Katelyn Stepan
- Department of Otolaryngology - Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Ethan Craig
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Scott Andrew Skillington
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brian C Deutsch
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie Chen
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nneoma S Wamkpah
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Craig A Bollig
- Department of Otolaryngology - Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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8
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Ben Arie G, Shafat T, Belochitski O, El-Saied S, Joshua BZ. Treatment Modality and Second Primary Tumors of the Head and Neck. ORL J Otorhinolaryngol Relat Spec 2021; 83:420-427. [PMID: 34587611 DOI: 10.1159/000513617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Second primary tumors (SPTs) in head and neck cancer are thought to occur from premalignant lesions that are present at the time of the primary tumor diagnosis. The association of the modality used to treat the primary lesion with SPT occurrence is not clear. OBJECTIVE The aim of the study was to assess the incidence of SPTs in patients with head and neck malignancies, according to treatment modality. METHODS We conducted a retrospective cohort study. All patients who were treated at Soroka Medical Center between 2000 and 2013 for a head and neck squamous cell carcinoma were assessed. Data analysis included tumor site of the primary and second primary and treatment modality of the primary tumor. In addition, demographics as well as habits were recorded as well. RESULTS Of the 184 patients included in the cohort, SPT developed in 31 patients (17%) with a median time to diagnosis of 4.3 years. Smoking was reported in 74% of those with SPT and 78% of those without. The most common site for SPT was the lungs, with 13 cases, 42% of the total SPTs. Among patients who developed an SPT, for 12 of those with an index tumor in the oral cavity or oro-hypopharynx, 8 (67%) developed an SPT in the same location; for 18 of those with an index tumor in the larynx, 11 (61%) developed a SPT in the lungs and bronchi (p = 0.001). On multivariate analysis, the treatment modality used was not found to be associated with the occurrence of SPTs and the radiotherapy showed no protective or harmful effect (HR 0.64 p = 0.24). CONCLUSION Treatment modality used for head and neck cancer does not seem to be associated with the occurrence of SPTs.
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Affiliation(s)
- Gal Ben Arie
- Department of Medical Imaging, Soroka University Medical Center, Beer- Sheva, Israel
| | - Tali Shafat
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Olga Belochitski
- Department of Oncology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology and Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ben-Zion Joshua
- Department of Otolaryngology and Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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9
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Milliet F, Bozec A, Schiappa R, Viotti J, Modesto A, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Sophie Ramay A, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Temam S, Mirghani H, Gorphe P, Chamorey E, Culié D. Metachronous second primary neoplasia in oropharyngeal cancer patients: Impact of tumor HPV status. A GETTEC multicentric study. Oral Oncol 2021; 122:105503. [PMID: 34500315 DOI: 10.1016/j.oraloncology.2021.105503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk to develop a metachronous second primary neoplasia (MSPN). HPV and non-HPV-related OPSCC are 2 distinct entities with biological, clinical and prognostic differences. The aims of our study were to analyze the impact of tumor HPV status and other relevant clinical factors, such as tobacco and/or alcohol (T/A) consumption, on the risk and distribution of MSPN in OPSCC patients and to assess the impact of MSPN on patient survival. MATERIAL AND METHODS All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. P16 immunohistochemical expression was used as a surrogate maker of tumor HPV status. The impact of tumor p16 status on the risk of MSPN was assessed in uni- and multivariate analyses. Overall survival (OS) was determined by Kaplan-Meier analysis. RESULTS Among the 1291 patients included in this study, 138 (10.7%) displayed a MSPN which was preferentially located in the head and neck area (H&N), lung and esophagus. Multivariate analyses showed that p16- tumor status (p = 0.003), T/A consumption (p = 0.005) and soft palate tumor site (p = 0.009) were significantly associated with a higher risk of MSPN. We found no impact of p16 tumor status on the median time between index OPSCC diagnosis and MSPN development, but a higher proportion of MSPN arising outside the H&N, lung and esophagus was found in p16 + than in p16- patients. MSPN development had an unfavorable impact (p = 0.04) on OS only in the p16 + patient group. CONCLUSION P16 tumor status and T/A consumption were the main predictive factors of MSPN in OPSCC patients. This study provides crucial results with a view to tailoring global management and follow-up of OPSCC patients.
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Affiliation(s)
- Florent Milliet
- Department of Otorhinolaryngology, University Hospital of Nice, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Otolaryngology and Head and Neck Surgery Department, European Hospital Georges Pompidou, APHP, Paris, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
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Frequency and Localization of Second Primary Tumors in Patients with Oropharyngeal Carcinoma-The Influence of the Human Papilloma Virus. Cancers (Basel) 2021; 13:cancers13081755. [PMID: 33916999 PMCID: PMC8067739 DOI: 10.3390/cancers13081755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Human papillomavirus (HPV) infection, smoking, and excessive alcohol consumption have been established as risk factors for the development of oropharyngeal squamous cell carcinoma (OPSCC). While the HPV epidemic has led to an increasing incidence of OPSCC, HPV-negative OPSCC cases associated with smoking and alcohol remain stable. As HPV-positive and -negative OPSCC present two distinct etiological, clinical, and prognostic entities, different treatment and follow-up strategies are being discussed. Still, specific surveillance strategies for HPV-positive OPSCC are lacking, as the risk of second primary tumors (SPT) in the era of HPV-associated OPSCC has not been comprehensively assessed. Our study investigated the frequency and localization of SPT of HPV-positive OPSCC, as well as their prognostic impact. We find that the SPT of HPV-positive OPSCC are less frequent than those of HPV-negative OPSCC, and they are also associated with higher survival rates. The localization of SPT of HPV-positive OPSCC did not differ from the localization of SPT of HPV-negative OPSCC. Abstract Purpose: To investigate the frequency, localization, and survival of second primary tumors (SPT) of oropharyngeal squamous cell carcinoma (OPSCC) depending on human papillomavirus (HPV) status. Methods: We performed a retrospective chart analysis of 107 OPSCC patients treated at the Zurich University Hospital from 2001 to 2010. Rate and localization of SPT after an index OPSCC were stratified according to smoking and HPV infection status. Results: In total, 57/91 (63%) included patients showed an HPV-associated OPSCC. Of these, 37/57 (64.9%) patients with an HPV-positive and 32/34 (94.1%) patients with an HPV-negative OPSCC were smokers. The median age at diagnosis of the SPT was 59.54 years (interquartile range 52.7–65.6). In addition, 8/57 (14%) HPV-positive and 13/34 (38.2%) HPV-negative patients developed SPT. The rate of SPT in patients with HPV-positive index tumors was significantly lower than in patients with HPV-negative OPSCC (p-value 0.01). Smokers showed significantly more SPT in the head and neck area than outside. The development of an SPT led to a significantly lower survival time in HPV-negative patients, while it did not significantly affect the survival time of HPV-positive patients. Conclusions: Patients with HPV-positive index tumors had a significantly lower risk of developing SPT than patients with HPV-negative tumors. If SPT developed, survival was significantly shorter in patients with HPV-negative tumors than with HPV-positive tumors.
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11
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Bollig CA, Lee DS, Mazul AL, Stepan K, Puram SV, Massa ST, Zenga J, Faden DL, Doering MM, Jackson RS, Pipkorn P. Systematic Review of Second Primary Oropharyngeal Cancers in Patients With p16+ Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2020; 164:733-740. [PMID: 32928026 DOI: 10.1177/0194599820951175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review the literature to determine the prevalence and clinical outcomes of second primary oropharyngeal squamous cell carcinoma (OPSCC). DATA SOURCES Search strategies created with a medical librarian were implemented using multiple databases in October 2019. REVIEW METHODS The population of interest included adults age >18 years with a p16+ or human papillomavirus-positive OPSCC. The outcome was a synchronous or metachronous second primary OPSCC. Inclusion and exclusion criteria were designed to capture all study designs. In total, 685 records were identified by the search strategy. Two reviewers independently performed the review, extracted data, and performed a quality assessment. Primary Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A random-effects model was used for the meta-analysis. RESULTS A total of 2470 patients with 35 second primary OPSCCs from 15 studies were identified. The pooled prevalence of second primary OPSCC was 1.4% (range, 0%-14.3%). In the random-effects model, the prevalence was estimated at 1.3% (95% CI, 0.7%-2.3%; P = .51, I2 = 52%). Of the 30 patients with treatment information, 26 (86.7%) received surgical treatment, while 4 (13.3%) underwent nonsurgical therapy. Of the 29 patients with available survival information, 22 (75.9%) had no evidence of disease at last follow-up, 5 (17.2%) ultimately died of disease, and 2 (6.9%) were alive with disease. CONCLUSION Overall, the rate of second primary OPSCC in patients with an index p16+ OPSCC is low, and most patients are successfully treated. Insufficient evidence currently exists to recommend routine elective tonsillectomy during surgical treatment of p16+ OPSCC.
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Affiliation(s)
- Craig A Bollig
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - David S Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Katelyn Stepan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Michelle M Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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12
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Chen SY, Massa S, Mazul AL, Kallogjeri D, Yaeger L, Jackson RS, Zevallos J, Pipkorn P. The association of smoking and outcomes in HPV-positive oropharyngeal cancer: A systematic review. Am J Otolaryngol 2020; 41:102592. [PMID: 32521295 DOI: 10.1016/j.amjoto.2020.102592] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/06/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE While smoking is linked to worse outcomes for human papillomavirus (HPV)-related oropharyngeal squamous cell cancer (OPSCC), the magnitude of this association and the amount of smoking exposure necessary to confer clinically significant differences in outcomes is unclear. Recent studies suggested that greater tobacco exposure results in higher risk of cancer progression and death. Our study objective was to perform a systematic review of the association between smoking and HPV-related OPSCC outcomes. MATERIALS AND METHODS A literature search was conducted in April 2019 to identify relevant articles using Embase, Medline, Scopus, CENTRAL, and Cochrane databases. All studies were independently screened by two investigators to identify studies that assessed HPV-positive patients as an independent cohort, specified smoking measures, and reported locoregional recurrence (LRR), overall survival (OS), disease-specific survival (DSS), or disease-free survival (DFS) in association with smoking. RESULTS Of 1130 studies identified, 10 met final inclusion criteria with 2321 total patients, mean age 57.5 years. Smoking measures included ever vs never, current vs never/former smokers, ≤10 vs >10 pack-year, and continuous pack-years. Of these studies, 8 (80%) showed a significant effect of smoking on increasing recurrence and mortality. Adjusted HRs for LRR ranged from 0.6 to 5.2, OS from 1.3 to 4.0, DSS from 2.3 to 7.2, and DFS from 1.02 to 4.2 among heavier smokers compared to lighter/non-smokers. CONCLUSIONS While there was significant variability in smoking metrics and reported outcomes, all studies reporting statistically significant HRs showed that smoking was associated with worse outcomes. Further studies using uniform smoking measures are necessary to better understand this association.
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13
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Abstract
Fluorine-18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography fused with computed tomography (PET/CT) is a valuable tool in surgical planning for head and neck squamous cell carcinoma (HNSCC). If performed prior to biopsy or other surgical intervention, FDG-PET/CT has high sensitivity for the detection of the primary site in patients with cervical lymph node metastases from unknown primary origin and can be used to direct the surgical workup. FDG-PET/CT is superior to CT alone for detection of nodal metastases outside the expected pattern or distant metastases or second primary cancers and can greatly affect determination of appropriate management including surgical eligibility. Prior to the advent of PET/CT, many patients undergoing (chemo)radiation-based therapy had planned post-treatment neck dissection; FDG-PET/CT now has a proven role in the evaluation of recurrent or persistent disease amenable to salvage surgery and enables safe avoidance of planned postradiation neck dissection with a high negative predictive value. Specifically for this important application, two standardized reporting metrics may be used in the head and neck anatomic region: the "Hopkins criteria" and the "Neck Imaging Reporting and Data System"; both systems produce a formalized evaluation and recommendation based on PET/CT findings. The role of PET/CT as a replacement for elective neck dissection or examination under anesthesia remains controversial but deserves further study. FDG-PET/CT has a wide-ranging impact on the surgical management of patients with HNSCC and should be used routinely in patients with unknown primary nodal disease and those presenting with advanced-stage cancers at initial staging and to assess treatment response.
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Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
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14
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Holstead R, Rasul R, Golden A, Kamdar D, Ghaly M, Teckie S, Frank D, Fantasia J, Seetharamu N. Identifying patterns of failure and secondary primary malignancies in HPV-related oropharyngeal squamous cell carcinomas. Future Oncol 2020; 16:199-207. [PMID: 31967480 DOI: 10.2217/fon-2019-0673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To compare patterns and rates of recurrence in patients with oropharyngeal squamous cell carcinoma by human papilloma virus (HPV) status. Patients & methods: Retrospective chart review of 155 patients diagnosed with oropharyngeal squamous cell carcinoma between 2012 and 2014 at a single center. Results: Two-year recurrence-free survival was higher in patients with HPV-positive tumors compared with negative (85.2% [standard error = 0.03] versus 59.3% [standard error = 0.09]; p < .001) with the former proportionally less likely to have locoregional recurrence. HPV-positive patients had proportionally higher incidence of second primary malignancies outside of head, neck and lung compared with HPV-negative (74.2 vs 37.5%; p = 0.09). Conclusion: The differences in failure by HPV status indicates a need for modified surveillance guidelines. The differences in second primary malignancies patterns are interesting, warranting further evaluation in larger studies.
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Affiliation(s)
- Ryan Holstead
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| | - Rehana Rasul
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| | - Anne Golden
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| | - Dev Kamdar
- Departement of Otolaryngology, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11040
| | - Maged Ghaly
- Department of Radiation Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11042
| | - Sewit Teckie
- Department of Radiation Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11042
| | - Douglas Frank
- Departement of Otolaryngology, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11040
| | - John Fantasia
- Department of Dental Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11040
| | - Nagashree Seetharamu
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
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15
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Adjei Boakye E, Buchanan P, Hinyard L, Osazuwa-Peters N, Schootman M, Piccirillo JF. Incidence and Risk of Second Primary Malignant Neoplasm After a First Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2019; 144:727-737. [PMID: 30027284 DOI: 10.1001/jamaoto.2018.0993] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Second primary malignant neoplasms (SPMNs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Recently, human papillomavirus (HPV) has emerged as a risk factor for oropharyngeal squamous cell carcinoma and has different prognosis from classic tobacco/alcohol-associated HNSCC. This suggests that there also may be different risks and burden of SPMNs among patients who's HNSCC were from HPV or tobacco and/or alcohol. Objective To assess SPMN risks and burden in a large US cohort of patients with a first potentially HPV-associated HNSCC vs non-HPV-associated HNSCC. Design, Setting, and Participants In this population-based retrospective cohort study, 109 512 adult patients diagnosed with HNSCC between 2000 and 2014 were identified from the Surveillance, Epidemiology, and End Results registry. Exposures HPV-relatedness based on whether patients' first HNSCC was potentially associated with HPV. Patients were grouped into 2 cohorts: potentially HPV-associated HNSCC, and non-HPV-associated HNSCC. Main Outcomes and Measures The primary outcome was incidence of SPMN (defined as the first subsequent primary cancer occurring at least 2 months after first cancer diagnosis). Excess SPMN risk was calculated using relative (standardized incidence ratios [SIRs]) and absolute (excess absolute risk [EAR] per 10 000 person-years at risk [PYR]). Results A total of 109 512 patients with HNSCC (mean [SD] age, 61.9 [12.1] years; 83 305 [76.1%] men) were identified. The overall SIR was 2.18 (95% CI, 2.14-2.22) corresponding to 160 excess cases per 10 000 PYR. The risk among patients with first potentially HPV-associated HNSCC (SIR, 1.98; EAR, 114 excess cases per 10 000 PYR) was lower than those with first non-HPV-associated HNSCC (SIR, 2.28; EAR, 188 excess cases per 10 000 PYR). Overall, the largest SIRs and EARs were observed for cancers of the head and neck, lung, and esophagus. However, the risks of SPMN were lower among potentially HPV-associated HNSCC patients. Conclusions and Relevance Patients diagnosed with HNSCC experience excess risk of SPMN, which was higher among those with non-HPV-associated HNSCC than from potentially HPV-associated HNSCC. Clinicians should implement strategies that prevent or detect SPMN early in patients with HNSCC.
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Affiliation(s)
- Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St Louis, Missouri
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St Louis, Missouri
| | - Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Mario Schootman
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.,Editor
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16
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Chaudhary S, Ganguly K, Muniyan S, Pothuraju R, Sayed Z, Jones DT, Batra SK, Macha MA. Immunometabolic Alterations by HPV Infection: New Dimensions to Head and Neck Cancer Disparity. J Natl Cancer Inst 2019; 111:233-244. [PMID: 30615137 PMCID: PMC6410958 DOI: 10.1093/jnci/djy207] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/29/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer, with high morbidity and mortality. Racial disparity in HNSCC is observed between African Americans (AAs) and whites, effecting both overall and 5-year survival, with worse prognosis for AAs. In addition to socio-economic status and demographic factors, many epidemiological studies have also identified factors including coexisting human papillomavirus (HPV) infection, primary tumor location, and a variety of somatic mutations that contribute to the prognostic incongruities in HNSCC patients among AAs and whites. Recent research also suggests HPV-induced dysregulation of tumor metabolism and immune microenvironment as the major regulators of HNSCC patient prognosis. Outcomes of several preclinical and clinical studies on targeted therapeutics warrant the need to elucidate the inherent mechanistic and population-based disparities underlying patient responses. This review systematically reports the underlying reasons for inconsistency in disease prognosis and therapy responses among HNSCC patients from different racial populations. The focus of this review is twofold: aside from discussing the causes of racial disparity, we also seek to identify the consequences of such disparity in terms of HPV infection and its associated mutational, metabolic, and immune landscapes. Considering the clinical impact of differential patient outcomes among AA and white populations, understanding the underlying cause of this disparity may pave the way for novel precision therapy for HNSCC.
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Affiliation(s)
- Sanjib Chaudhary
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Koelina Ganguly
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Sakthivel Muniyan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Ramesh Pothuraju
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Zafar Sayed
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Dwight T Jones
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Muzafar A Macha
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
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17
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Is there a patient population with squamous cell carcinoma of the head and neck region who might benefit from de-intensification of postoperative radiotherapy? : A monocentric retrospective analysis of a previously defined low-risk patient population treated with standard-of-care radiotherapy. Strahlenther Onkol 2019; 195:482-495. [PMID: 30610355 DOI: 10.1007/s00066-018-1415-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the clinical outcome of a previously defined low-risk patient population with completely resected (R0) squamous cell carcinoma of the oral cavity, oropharynx, larynx (pT1-3, pN0-pN2b), hypopharynx (pT1-2, pN0-pN1), and the indication for postoperative radio(chemo)therapy. PATIENTS AND METHODS According to predefined criteria, 99 patients with head and neck squamous cell carcinoma (SCC) who were treated at our institution from January 1, 2005 to December 31, 2014, were available for analysis. The Kaplan-Meier method was used for calculating survival and incidence rates. For univariate comparative analysis, the log-rank test was used for analyzing prognostic clinicopathologic parameters. RESULTS Median follow-up was 67 months. Cumulative overall (OS) and disease-free survival (DFS) were 97.9%/94.7%/88.0% and 96.9%/92.6%/84.7% after 1, 2, and 5 years, respectively. Cumulative incidence of loco-regional recurrence (LRR), distant metastases (DM), and second cancer (SC) were 1.0%/1.0%/4.9%, 0.0%/3.4%/5.8%, and 2.1%/4.2%/13.1%, respectively. In univariate comparative analysis, location of the primary tumor in the oropharynx was a significant predictor for increased OS (p = 0.043) and DFS (p = 0.048). CONCLUSION Considering the low disease relapse rates and high rates of therapy-induced late side effects, as well as the increased risk of developing SC, a prospective multicentric trial investigating de-escalation of radiotherapy in this clearly defined low-risk patient population was started and is still recruiting patients (DIREKHT-Trial, NCT02528955).
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18
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Adjei Boakye E, Buchanan P, Hinyard L, Stamatakis K, Osazuwa-Peters N, Simpson MC, Schootman M, Piccirillo JF. Risk and outcomes for second primary human papillomavirus-related and -unrelated head and neck malignancy. Laryngoscope 2018; 129:1828-1835. [PMID: 30582167 DOI: 10.1002/lary.27634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 10/03/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from an index human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) and HPV-unrelated HNSCC and to 2) compare overall survival between those with HPV-related and HPV-unrelated index HNSCC among patients who develop SPM. STUDY DESIGN Retrospective cohort analysis. METHODS A retrospective study was conducted of 113,259 patients who were diagnosed with HNSCC from 2000 to 2014. SPM was defined as the first subsequent primary cancer occurring at least 2 months after index cancer diagnosis, and HPV-relatedness was based on whether patients' index HNSCC was potentially HPV-related or HPV-unrelated. Multivariable Fine and Gray (FG) competing-risks regression models were used to estimate factors associated with risk of SPM by HPV-relatedness. Among patients with SPM, an adjusted Cox proportional hazards (PH) regression model was used to assess the association between HPV-relatedness and survival. RESULTS Approximately 13,900 patients (12.3%) developed SPM. In the FG model, patients with HPV-unrelated HNSCC had a 15% higher risk of developing SPM (adjusted hazard ratio: 1.15, 95% confidence interval: 1.10-1.20) than those with potentially HPV-related HNSCC, but the same characteristics were associated with SPM development. In the Cox PH model, patients with SPM whose index HNSCC was HPV-unrelated had higher risk of death than those whose index HNSCC was potentially HPV-related (adjusted hazard ratio: 1.06; 95% confidence interval: 1.02-1.11). CONCLUSIONS Patients with HPV-unrelated HNSCC have a higher risk of SPM development than do those with HPV-related HNSCC. Effective secondary disease-prevention strategies should be established to improve long-term patient outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 129:1828-1835, 2019.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.,Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | - Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | - Katie Stamatakis
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri.,Saint Louis University Cancer Center, St. Louis, Missouri.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mario Schootman
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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Lop J, García J, López M, Taberna M, Mena M, Alemany L, Quer M, León X. Competing mortality in oropharyngeal carcinoma according to human papillomavirus status. Head Neck 2018; 41:1328-1334. [PMID: 30549389 DOI: 10.1002/hed.25559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/24/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human papillomavirus (HPV) status. METHODS We studied retrospectively 423 patients with OPC with known HPV status. Among the patients included in the study, 53 (12.5%) were HPV-positive. We analyzed overall survival and competing causes of mortality according to the HPV status of the patients. RESULTS Patients with HPV-negative tumors had lower OPC cancer-specific survival (P = .0001), second primary neoplasm survival (P = .0001), and noncancer-related causes survival (P = .13) than patients with HPV-positive tumors. This resulted in significant differences in overall survival depending on HPV status (P = .0001). CONCLUSION Conclusion: HPV-positive OPC has a better overall survival than HPV-negative OPC. Patients with HPV-positive tumors presented a significant lower OPC cancer-specific and second primary neoplasm mortality and a marginally nonsignificant lower noncancer mortality as compared to HPV-negative tumors.
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Affiliation(s)
- Joan Lop
- Otorhinolaryngology Department, Hospital Parc Taulí, Universitat Autònonoma de Barcelona, Sabadell, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Crippen MM, Brady JS, Burke LA, Eloy JA, Baredes S, Park RCW. Second primary lung malignancy following head and neck squamous cell carcinoma. Laryngoscope 2018; 129:903-909. [DOI: 10.1002/lary.27422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Meghan M. Crippen
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
| | - Jacob S. Brady
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
| | - Lindsay A. Burke
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
- Center for Skull Base and Pituitary SurgeryNeurological Institute of New Jersey, Rutgers New Jersey Medical School Newark New Jersey
- Department of Neurological SurgeryRutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
- Center for Skull Base and Pituitary SurgeryNeurological Institute of New Jersey, Rutgers New Jersey Medical School Newark New Jersey
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark New Jersey
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21
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Taberna M, Mena M, Pavón MA, Alemany L, Gillison ML, Mesía R. Human papillomavirus-related oropharyngeal cancer. Ann Oncol 2018. [PMID: 28633362 DOI: 10.1093/annonc/mdx304] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
High-risk human papillomavirus (HPV) is now recognised as the principal cause of the increasing incidence rates of oropharyngeal squamous cell carcinoma (OPSCC) in some parts of the world. The primary risk factor for developing HPV-related OPSCC is oral HPV-infection and the majority of oral HPV-infections are acquired by oral sex. Progression into an OPSCC includes persistent infection with evasion of immune response in the microenvironment, the activation of viral early genes (E6, E7) in basal epithelial cells, the deregulation of cell cycle and the accumulation of chromosomal instability. Patients affected by HPV-related OPSCC tend to be younger and have better outcomes. This observation has lead current research to evaluate treatment de-escalation options to reduce long-term associated morbidity. Moreover, a different molecular profile for HPV-related OPSCC has been described, opening new options for targeted therapy and immunotherapy approaches. This paper comprehensively reviews our accumulated knowledge regarding the role of HPV in OPSCC spanning from infection to cancer development, including its clinical diagnosis, management and preventive strategies.
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Affiliation(s)
- M Taberna
- Department of Medical Oncology;; Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona;; Department of Medicine, University of Barcelona, Barcelona;.
| | - M Mena
- Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona;; CIBER in primary and secondary prevention of viral induced cancers (CIBERONC), Madrid, Spain
| | - M A Pavón
- Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona
| | - L Alemany
- Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona;; Epidemiology and Public Health, Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - M L Gillison
- Department of Medicine, The Ohio State University, Columbus, USA
| | - R Mesía
- Department of Medical Oncology;; Department of Medicine, University of Barcelona, Barcelona
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22
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Nami Saber C, Grønhøj C, Jensen DH, Nørregaard C, Carlander A, Garnæs E, Kiss K, Specht L, von Buchwald C. Synchronous, bilateral tonsillar carcinomas: Patient characteristics and human papillomavirus genotypes. Oral Oncol 2017; 74:105-110. [PMID: 29103737 DOI: 10.1016/j.oraloncology.2017.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing, but data on the incidence of synchronous, bilateral tonsillar squamous cell carcinomas (BiTSCCs) is sparse. In this study, we report the incidence and tumour characteristics of BiTSCCs in a population-based, consecutive cohort of OPSCCs. METHODS We identified all patients diagnosed with tonsillar squamous cell carcinoma (TSCC) in eastern Denmark during a 15-year period to detect the incidence of synchronous BiTSCCs. The tumours were assessed for p16Ink4a expression, the presence of HPV DNA and HPV genotypes. Furthermore, we systematically reviewed the literature examining BiTSCCs. RESULTS Of the total of 1119 TSCCs diagnosed in eastern Denmark from 2000 to 2014, we identified 12 BiTSCCs, nine of which initially presented as a cancer of unknown primary (CUP) in the neck. Nine cases were bilaterally HPV16 positive (HPV16+), while two cases were HPV16+ in one tonsil and respectively, HPV33 and HPV35 positive in the contralateral tonsil. One case was bilaterally HPV-negative. We also identified an increase in the incidence of BiTSCCs after 2012 when histological examination of the entire tonsil tissue became routine, suggesting that BiTSCCs might be underdiagnosed. In the literature, we identified 15 studies from six countries, encompassing 25 cases in total. CONCLUSIONS BiTSCCs were primarily HPV16+ and were most often diagnosed as part of the diagnostic work-up for CUP. We found an incidence of 9% BiTSCCs in patients with TSCC after 2012 and we therefore recommend focusing on putative BiTSCC with total embedding and histological examination of tonsils harvested by bilateral tonsillectomies.
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Affiliation(s)
- Camelia Nami Saber
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - David Hebbelstrup Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Cecilie Nørregaard
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Amanda Carlander
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Emilie Garnæs
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Katalin Kiss
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Denmark.
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Wang X, Mauer EA, Christos P, Manzerova J, Wernicke AG, Parashar B. First Clinical Report on Comparative Treatment and Survival Outcomes in Second Cancers after Primary Head and Neck Cancer: A Population-Based Study. Cureus 2017; 9:e1284. [PMID: 28680772 PMCID: PMC5491341 DOI: 10.7759/cureus.1284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction To compare patients’ survival of second primary malignancy (SPM) after head and neck squamous cell carcinoma (HNSCC). Methods The Surveillance, Epidemiology, and End Results (SEER) database was utilized (1973-2011). The Kaplan-Meier method with log-rank test was used to compare the overall survival (OS) and cause-specific survival (CSS) among treatment methods from the time of diagnosis of SPMs. Cox proportional regression models were used to adjust the impact for risk factors on CSS. Results A total of 3,038 patients were identified (5-yr OS 22.6% (21.0-24.3%)). For head and neck (HN) SPMs, the patients who received ‘conservative surgery with radiation’ had the best 5-yr OS (65.2% (48.9-86.9%)); and the ‘conservative surgery’ group had the best 5-yr CSS (89.9% (85.6-94.5%)). For lung SPMs, the ‘radical surgery’ group showed the best survival (2-yr OS 60.8% (56.0-66.1%), 2-yr CSS 70.6% (65.8-75.8%), respectively). Esophagus SPMs had poor prognosis, with no difference among the treatment groups. In lung SPMs, younger age (p<0.001) and black race (p<0.05) were most favorable CSS predictors. Conclusions The prognosis of SPMs after HNSCC is worse compared with corresponding primary tumor. Conservative surgery with or without radiation showed the most favorable outcomes in HN SPMs.
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Affiliation(s)
- Xin Wang
- Stich Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center
| | - Elizabeth A Mauer
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian/Weill Cornell Medical Center
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian/Weill Cornell Medical Center
| | - Julia Manzerova
- Stich Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center
| | | | - Bhupesh Parashar
- Stich Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center
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24
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A 5‑year update of patients with HPV positive versus negative oropharyngeal cancer after radiochemotherapy in Austria. Wien Klin Wochenschr 2017; 129:398-403. [PMID: 28204968 PMCID: PMC5486734 DOI: 10.1007/s00508-017-1171-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/18/2016] [Indexed: 11/25/2022]
Abstract
Background After publishing promising results for the treatment of patients with human papilloma virus (HPV) positive oropharyngeal cancer with radiochemotherapy regarding 2‑year survival, we present an update of the disease-specific and disease-free survival after 5 years. Patients and methods A total of 29 patients of which 18 were HPV negative and 11 HPV positive with squamous cell carcinoma of the oropharynx received radiation therapy with or without chemotherapy (cisplatin) or immunotherapy (cetuximab) between 2007 and 2009. At time of the present analysis, six patients are still alive including four with HPV positive and two with HPV negative oropharyngeal carcinoma, while 15 out of 16 patients with HPV negative tumors died and 1 died of another cause with evidence of disease. Results Since the 2‑year disease-specific survival of patients with HPV positive cancer of the oropharynx was published with 100% versus 30.4% in HPV negative tumors, we now present the 5‑year disease-specific survival after treatment, which was 85.7% in HPV positive versus 11.1% in HPV negative patients. Conclusion We present the results of patients receiving radiochemo(immuno)therapy for oropharyngeal cancer regarding the HPV status, which is still promising.
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25
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Martel M, Alemany L, Taberna M, Mena M, Tous S, Bagué S, Castellsagué X, Quer M, León X. The role of HPV on the risk of second primary neoplasia in patients with oropharyngeal carcinoma. Oral Oncol 2016; 64:37-43. [PMID: 28024722 DOI: 10.1016/j.oraloncology.2016.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/15/2016] [Accepted: 11/24/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES It has been reported that patients with HPV-positive oropharyngeal cancer (OPC) have a lower risk of appearance of second primary neoplasm (SPN) than HPV-negative OPC patients. The aim of our study was to analyze the risk of developing SPN in a large group of patients with OPC according to HPV status in the primary tumor. MATERIALS AND METHODS We included 412 OPC patients treated at our center from 1991 to 2014 for which the HPV DNA positivity was evaluated by PCR in available tumor specimens. HPV DNA positive samples were further tested for HPV E6∗I mRNA detection and/or p16INK4a immunohistochemistry. We estimated the incidence of SPN in all cancer sites and in cancer sites related to tobacco and alcohol consumption according to the HPV status in the primary tumor. RESULTS Fifty-one (12.4%) out of 412 OPCs included in the study were HPV-related. Five-year SPN-free survival for HPV-negative versus HPV-positive OPC patients was 57.0% and 89.0% (P<0.001), respectively. Corresponding estimates for 10-year SPN-free survival were 35.2% versus 78.5% (P<0.001). When restricting the analyses to tobacco/alcohol-related SPNs, the corresponding survival rates where 62.0% versus 97.6% (P<0.001) and 42.2% versus 97.6%, (P<0.001), for 5-year and 10-year survival rates, respectively. HPV status and previous toxic habits might allow classifying patients regarding the risk of tobacco/alcohol-related SPNs. CONCLUSION HPV-related OPC patients have a significant lower risk of SPN development, particularly in those locations related to tobacco use or alcohol consumption.
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Affiliation(s)
- María Martel
- Otorhinolaryngology Department, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Miren Taberna
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain; Medical Oncology Department, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Silvia Bagué
- Pathology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Xavier Castellsagué
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
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Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, Elicin O, Skanjeti A, Giammarile F, Bilbao P, Casquero F, de Bari B, Dal Pra A. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol 2016; 89:20160217. [PMID: 27416996 DOI: 10.1259/bjr.20160217] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT (18F-FDG-PET/CT) rapidly gained clinical acceptance, and it has become an important imaging tool in routine clinical oncology. However, controversial data are currently available, for example, on the role of 18F-FDG-PET/CT imaging during radiotherapy planning, the prognostic value or its real clinical impact on treatment decisions. In this article, the role of 18F-FDG-PET/CT imaging in HNSCC during pre-treatment staging, radiotherapy planning, treatment response assessment, prognosis and follow-up is reviewed focusing on current evidence and controversial issues. A proposal on how to integrate 18F-FDG-PET/CT in daily clinical practice is also described.
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Affiliation(s)
- Jon Cacicedo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC)
| | - Arturo Navarro
- 3 Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Del Hoyo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Alfonso Gomez-Iturriaga
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Filippo Alongi
- 4 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Jose A Medina
- 2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC).,5 Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Olgun Elicin
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Skanjeti
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francesco Giammarile
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pedro Bilbao
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Francisco Casquero
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Berardino de Bari
- 8 fESTRO Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Alan Dal Pra
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
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Halimi C, Barry B, De Raucourt D, Choussy O, Dessard-Diana B, Hans S, Lafarge D. Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Diagnosis of local recurrence and metachronous locations in head and neck oncology. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:287-90. [DOI: 10.1016/j.anorl.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Diaz DA, Reis IM, Weed DT, Elsayyad N, Samuels M, Abramowitz MC. Head and neck second primary cancer rates in the human papillomavirus era: A population-based analysis. Head Neck 2015; 38 Suppl 1:E873-83. [DOI: 10.1002/hed.24119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dayssy Alexandra Diaz
- Department of Radiation Oncology; University of Miami Sylvester Comprehensive Cancer Center; Miami Florida
| | - Isildinha M. Reis
- Department of Public Health Sciences; University of Miami Sylvester Comprehensive Cancer Center; Miami Florida
| | - Donald T. Weed
- Department of Otolaryngology; University of Miami Sylvester Comprehensive Cancer Center; Miami Florida
| | - Nagy Elsayyad
- Department of Radiation Oncology; University of Miami Sylvester Comprehensive Cancer Center; Miami Florida
| | - Michael Samuels
- Department of Radiation Oncology; University of Miami Sylvester Comprehensive Cancer Center; Miami Florida
| | - Matthew C. Abramowitz
- Department of Radiation Oncology; University of Miami Sylvester Comprehensive Cancer Center; Miami Florida
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Jung YS, Lim J, Jung KW, Ryu J, Won YJ. Metachronous Second Primary Malignancies after Head and Neck Cancer in a Korean Cohort (1993-2010). PLoS One 2015. [PMID: 26218068 PMCID: PMC4517809 DOI: 10.1371/journal.pone.0134160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Second primary malignancy (SPM) is the major long-term cause of patient mortality with head and neck squamous cell carcinoma (HNSCC). As the incidence of high-risk human papillomavirus (HPV)-related HNSCC is increasing globally, we analyzed the patterns of SPM occurrence, the effect of the index tumor site along with attributes to HPV, and the effect of SPM on survival in South Korean patients with head and neck cancer (HNC). Data were retrieved from the Korea Central Cancer Registry, a nationwide population-based cancer registry, from 1993 to 2010. Standardized incidence ratios were analyzed and compared between index tumor sites, particularly oropharyngeal vs. non-oropharyngeal sites. After adjustment for competing risks, 3- and 5-year SPM rates were calculated using the cumulative incidence function. The effects of SPM occurrence on overall survival (OS) were then analyzed. SPM rates were significantly lower for HPV-attributable oropharyngeal sites than for non-oropharyngeal sites, such as the larynx and hypopharynx (p<0.001). SPM rates were also lower for oral cavity first primary sites than for non-oropharyngeal first primary sites (p<0.001). SPMs typically occurred in the esophagus, lungs and the head and neck. Uterine cervical cancers occurred significantly more frequently after index oropharyngeal cancer in women. The 5-year and 10-year OS rates were 57.8 and 45.7% in all HNC patients, respectively. The OS after SPM occurrence was poor (5-year, 31.8%; 10-year, 20.8%) compared to after index HNC occurrence (5-year, 68.4%; 10-year, 41.2%). SPM occurrence in the esophagus and lung/bronchus showed a worse OS than SPM localized to the head and neck. South Korean HNC patient, the first primary cancer site affected SPM risk and distribution. The 5- and 10-year OS rates deteriorated after SPM occurrence, particularly in the esophagus and lungs. Further optimization of follow-up strategies for effective surveillance of SPM, particularly in the esophagus and lungs, is warranted.
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Affiliation(s)
- Yuh-S Jung
- Specific Organs Cancer Branch, Department of Otolaryngology, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jiwon Lim
- Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
| | - Junsun Ryu
- Specific Organs Cancer Branch, Department of Otolaryngology, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
- * E-mail:
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Khariwala SS, Moore MG, Malloy KM, Gosselin B, Smith RV. The "HPV Discussion": Effective Use of Data to Deliver Recommendations to Patients Impacted by HPV. Otolaryngol Head Neck Surg 2015. [PMID: 26220060 DOI: 10.1177/0194599815597200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The dramatic rise in oropharyngeal squamous cell carcinoma associated with the human papilloma virus (HPV) has brought significant change to the interaction between patients and head and neck oncologists. HPV-induced cancers are generally the result of elements from the patient's sexual history, and otolaryngologists are generally less experienced than primary care physicians in addressing patient questions relating to sexual history and practices. This article addresses questions commonly posed by patients relating to HPV-induced head and neck cancers, issues related to HPV vaccination, and surveillance of HPV-related lesions. Supporting data are provided such that physicians may be better equipped to sufficiently address patient queries on this topic. DATA SOURCES Available peer-reviewed literature and clinical practice guidelines. REVIEW METHODS Assessment and discussion of specific topics by authors selected from the Head and Neck Surgery Education Committee of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. RESULTS An educational "miniseminar" resulted in a notable increase in attendee knowledge and comfort regarding oropharyngeal squamous cell carcinoma counseling for patients in the setting of HPV-positive disease. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The dramatic increase in HPV-associated head and neck cancers has resulted in a changed paradigm of the physician-patient interaction. Care providers in today's environment must be prepared to counsel patients regarding sexually transmitted diseases and high-risk sexual behaviors. Examination of the existing data provides the foundation with which to construct a framework in which physicians can effectively communicate information and recommendations as they pertain to HPV-related carcinoma.
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Affiliation(s)
- Samir S Khariwala
- Department Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael G Moore
- Department Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Kelly M Malloy
- Department Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benoit Gosselin
- Department Otolaryngology-Head and Neck Surgery, Dartmouth Medical Center, Manchester, New Hampshire, USA
| | - Richard V Smith
- Department Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
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Surgery Versus Radiotherapy for Early Oropharyngeal Tumors: a Never-Ending Debate. Curr Treat Options Oncol 2015; 16:42. [DOI: 10.1007/s11864-015-0362-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tantiwongkosi B, Yu F, Kanard A, Miller FR. Role of 18F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma. World J Radiol 2014; 6:177-191. [PMID: 24876922 PMCID: PMC4037544 DOI: 10.4329/wjr.v6.i5.177] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Head and neck cancer (HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma (HNSCC). The majority of patients present with complicated locally advanced disease (typically stage III and IV) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Some patients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography (CT) or magnetic resonance imaging (MRI). 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography/CT (18F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.
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Pytynia KB, Dahlstrom KR, Sturgis EM. Epidemiology of HPV-associated oropharyngeal cancer. Oral Oncol 2014; 50:380-6. [PMID: 24461628 PMCID: PMC4444216 DOI: 10.1016/j.oraloncology.2013.12.019] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 11/12/2013] [Accepted: 12/17/2013] [Indexed: 02/06/2023]
Abstract
Squamous cell carcinoma of the oropharynx is increasing in incidence in epidemic proportion. This site specific increase in incidence is due to an increase in human papillomavirus (HPV)-related squamous cell carcinoma, while the incidence of tobacco related squamous cell carcinoma is decreasing. In particular, the incidence of HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is increased among middle aged white men, and sexual behavior is a risk factor. HPV-related oropharyngeal squamous cell carcinoma represents a growing etiologically distinct subset of head and neck cancers with unique epidemiological, clinical, and molecular characteristics that differ from those of HPV-unassociated cancers. In this review, we discuss the epidemiology of HPV-related OPSCC, the prevalence of oral/oropharyngeal HPV infection, and efforts aimed at reducing the incidence of HPV-related OPSCC.
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Affiliation(s)
- Kristen B Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Saito Y, Ebihara Y, Ushiku T, Omura G, Kobayashi K, Ando M, Sakamoto T, Fukayama M, Yamasoba T, Asakage T. Negative Human Papillomavirus Status and Excessive Alcohol Consumption are Significant Risk Factors for Second Primary Malignancies in Japanese Patients with Oropharyngeal Carcinoma†. Jpn J Clin Oncol 2014; 44:564-9. [DOI: 10.1093/jjco/hyu042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baumeister P, Reiter M, Welz C, Becker S, Betz C, Harréus U. Surgically treated oropharyngeal cancer: risk factors and tumor characteristics. J Cancer Res Clin Oncol 2014; 140:1011-9. [PMID: 24615330 DOI: 10.1007/s00432-014-1631-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/27/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess risk factors of patients with oropharyngeal squamous cell carcinoma in the Munich area of Southern Germany in relation to human papillomavirus (HPV) association of the tumors. To demonstrate differences in tumor characteristics and their impact on adjuvant treatment. METHODS Between November 2010 and July 2013, patients were prospectively interviewed for risk factors before they underwent surgical resection of their tumors. HPV association was evaluated by p16 immunohistochemistry; tumor characteristics and type of adjuvant treatment were recorded. Follow-up data were collected after a median follow-up of 12.1 month. RESULTS In contrast to many recent studies, we could not detect any difference in overall age and age at sexual debut between p16-positive and p16-negative patients. P16-negative patients are characterized by a more intensive tobacco and alcohol use, a more abusive way of consumption, less nonoral and less oral sex partners. P16-positive patients had a significantly higher risk of lymph node metastases, but nevertheless a significant lower risk to recur or to die. No difference in the incidence of synchronous second primary tumors was seen. P16-positive patients generally received a more aggressive adjuvant treatment because of more frequently involved lymph nodes. CONCLUSION Lifestyle risk factors such as smoking, drinking, and sexual habits were independent from age, but showed marked differences between the p16-positive and p16-negative group. Since p16-positive patients were treated more aggressively, it is not possible to distinguish whether the better outcome of HPV-positive patients is a result of less aggressive cancers or more aggressive treatment. With regard to the ongoing debate about treatment deintensification, we should keep in mind that the survival of HPV-positive cancer patients is not 100 %.
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Affiliation(s)
- Philipp Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany,
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Thavaraj S, Stokes A, Mazuno K, Henley-Smith R, Suh YE, Paleri V, Tavassoli M, Odell E, Robinson M. Patients with HPV-related tonsil squamous cell carcinoma rarely harbour oncogenic HPV infection at other pharyngeal sites. Oral Oncol 2014; 50:241-6. [PMID: 24434066 DOI: 10.1016/j.oraloncology.2013.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/27/2013] [Accepted: 12/14/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) have a reduced risk of developing second primary upper aerodigestive tract (UADT) tumours compared to patients with HPV-negative primary tumours at the same site. To determine whether this finding might be explained by a lack of viral-induced field cancerisation or multifocal infection, we investigated whether there was epithelial dysplasia and/or evidence of HPV infection at other pharyngeal mucosal sites in patients presenting with the disease. MATERIALS AND METHODS Sixty-three patients with primary tonsil SCC and 108 pharyngeal endoscopic biopsies, representing at least one pharyngeal subsite from each patient, were included in this study. Tissue samples were tested using HPV PCR (GP5+/6+), p16 immunohistochemistry (IHC) and high risk HPV DNA in situ hybridisation (ISH). RESULTS There were 46 patients with HPV-related SCC and 17 patients with HPV-negative disease. PCR detected HPV DNA in a fifth of pharyngeal endoscopic biopsies and was equally likely to be from a patient with HPV-related SCC as from a patient with HPV negative disease. All PCR positive cases were tested using p16 IHC and high risk HPV ISH and only three biopsies were positive. Significantly, these three biopsies all showed evidence of epithelial dysplasia and were from patients with an HPV positive index tumour. CONCLUSION Our data suggest that virus-induced field cancerisation and/or multifocal oncogenic HPV infection of the pharynx is uncommon in OPSCC and supports the concept that these patients have a lower risk of developing second primary tumours of the UADT.
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Affiliation(s)
- Selvam Thavaraj
- Oral Pathology, King's College London Dental Institute, London, United Kingdom.
| | - Angela Stokes
- Oral Pathology, King's College London Dental Institute, London, United Kingdom
| | - Kazuya Mazuno
- Department of Oral Pathology, Osaka Dental University, Osaka, Japan
| | - Rhonda Henley-Smith
- Oral Pathology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Yae-Eun Suh
- Oral Pathology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vinidh Paleri
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Trust, United Kingdom
| | - Mahvash Tavassoli
- Molecular Oncology, King's College London Dental Institute, London, United Kingdom
| | - Edward Odell
- Oral Pathology, King's College London Dental Institute, London, United Kingdom
| | - Max Robinson
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Pytynia KB, Dahlstrom KR, Sturgis EM. Clinical management of squamous cell carcinoma of the oropharynx: how does this differ for HPV-related tumors? Future Oncol 2013; 9:1413-6. [PMID: 23777275 DOI: 10.2217/fon.13.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kristen B Pytynia
- Department of Head & Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Gan SJ, Dahlstrom KR, Peck BW, Caywood W, Li G, Wei Q, Zafereo ME, Sturgis EM. Incidence and pattern of second primary malignancies in patients with index oropharyngeal cancers versus index nonoropharyngeal head and neck cancers. Cancer 2013; 119:2593-601. [PMID: 23605777 DOI: 10.1002/cncr.28107] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/08/2013] [Accepted: 03/13/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND A recent review of the Surveillance, Epidemiology, and End Results registry suggested that patients with index squamous cell carcinoma (SCC) of the oropharynx (SCCOP) are less likely to develop second primary malignancies (SPM) than patients with index SCC of nonoropharyngeal sites (oral cavity, larynx, hypopharynx). The objectives of this study were to determine the impact of index primary tumor site on SPM risk and to explore factors that potentially affect this risk within a large, prospectively accrued cohort of patients with index SCC of the head and neck (SCCHN). METHODS A cohort of 2230 patients with incident SCCHN was reviewed for development of SPM. Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards models were used to detect the impact of various factors, including index tumor site, on SPM risk. RESULTS The SPM rate was lower for patients with index SCCOP than for patients with index nonoropharyngeal cancer (P < .001). Among patients with SCCOP, former smokers had a 50% greater risk of SPM, and current smokers had a 100% greater risk of SPM than never-smokers (Ptrend = .008). Also among patients with SCCOP, those with the classic SCCHN phenotype had an SPM risk similar to that of patients with index nonoropharyngeal cancers; those with a typical human papillomavirus phenotype had a very low SPM risk. SPM most commonly occurred at nontobacco-related sites in patients with index SCCOP and at tobacco-related sites in patients with index nonoropharyngeal cancers. CONCLUSIONS In patients with SCCHN, index cancer site and smoking status affect the risk and distribution of SPM.
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Affiliation(s)
- Samuel J Gan
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Atienza JAS, Dasanu CA. Incidence of second primary malignancies in patients with treated head and neck cancer: a comprehensive review of literature. Curr Med Res Opin 2012; 28:1899-909. [PMID: 23121148 DOI: 10.1185/03007995.2012.746218] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increased incidence of a second primary aero-digestive malignancy after an index head and neck cancer (HNC) is well-documented. Furthermore, a clear set of surveillance strategies for second primary aero-digestive cancers in these patients exists. METHODS The goal of this article is to review the published literature on risk of second primary malignancies (SPMs) (including aero-digestive malignancies) after a treated index HNC as well as its associated predictors, prognosis and surveillance. Most relevant publications were identified through searching the PubMed database for articles published up to July 2012; epidemiologic evidence was synthesized and thoroughly analyzed. FINDINGS Data from randomized controlled trials, meta-analyses, population-based and cohort group studies, prior reviews, and case reports indicate an increased incidence of various SPMs after occurrence of a HNC. These cancers are not limited to upper aero-digestive sites. Common risk factors including environmental, genetic and immune factors may explain the increased incidence of second cancers in this patient population. In addition, site of the index HNC may predict the site of a future SPM. CONCLUSIONS As a general rule, oral cavity and oropharyngeal squamous cell cancers are associated more with head and neck region SPM, while laryngeal and hypopharyngeal cancers - with that of the lung. As these cancers confer dismal prognosis and shorter survival in patients with HNCs, several literature sources recommend close surveillance for and an aggressive therapy of SPM. Notwithstanding, their optimal management and follow-up schedule remains to be established.
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Affiliation(s)
- Jonessa Ann S Atienza
- University of Connecticut, Department of Internal Medicine, Farmington, CT 06030, USA.
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