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Lu Z, Zhou X, Fu L, Li Y, Tian T, Liu Q, Zou H. Prognostic prediction models for oropharyngeal squamous cell carcinoma (OPSCC): a protocol for systematic review, critical appraisal and meta-analysis. BMJ Open 2023; 13:e073375. [PMID: 37827742 PMCID: PMC10582955 DOI: 10.1136/bmjopen-2023-073375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/25/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Oropharyngeal squamous cell carcinoma (OPSCC) is increasingly prevalent and has significantly heterogeneous risks of survival for diagnosed individuals due to the inter-related risk factors. Precise prediction of the risk of survival for an individual patient with OPSCC presents a useful adjunct to therapeutic decision-making regarding the management of OPSCC. The aim of this systematic review, critical appraisal and meta-analysis is to assess prognostic prediction models for OPSCC and lay a foundation for future research programmes to develop and validate prognostic prediction models for OPSCC. METHODS AND ANALYSIS This protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocol statement. Based on predefined criteria, electronic databases including MEDLINE, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure (CNKI) will be searched for relevant studies without language restrictions from inception of databases to present. This study will systematically review published prognostic prediction models for survival outcomes in patients with OPSCC, describe their characteristics, compare performance and assess risk of bias and real-world clinical utility. Selection of eligible studies, data extraction and critical appraisal will be conducted independently by two reviewers. A third reviewer will resolve any disagreements. Included studies will be systematically summarised using appropriate tools designed for prognostic prediction modelling studies. Risk of bias and quality of studies will be assessed using the Prediction Model Risk of Bias Assessment Tool and the Transparent Reporting of a multivariable prediction model for individual prognosis or diagnosis. Performance measures of these models will be pooled and analysed with meta-analyses if feasible. ETHICS AND DISSEMINATION This review will be conducted completely based on published data, so approval from an ethics committee or written consent is not required. The results will be disseminated through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42023400272.
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Affiliation(s)
- Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Tian Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Qi Liu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Abstract
Purpose of Review This study assesses the current state of knowledge of head and neck squamous cell carcinomas (HNSCC), which are malignancies arising from the orifices and adjacent mucosae of the aerodigestive tracts. These contiguous anatomical areas are unique in that 2 important human oncoviruses, Epstein-Barr virus (EBV) and human papillomavirus (HPV), are causally associated with nasopharyngeal and oropharyngeal cancers, respectively. Mortality rates have remained high over the last 4 decades, and insufficient attention paid to the unique viral and clinical oncology of the different subgroups of HNSCC. Recent Findings We have compared and contrasted the 2 double-stranded DNA viruses and the relevant molecular oncogenesis of their respective cancers against other head and neck cancers. Tobacco and alcohol ingestion are also reviewed, as regard the genetic progression/mutation accumulation model of carcinogenesis. The importance of stringent stratification when searching for cancer mutations and biomarkers is discussed. Evidence is presented for a dysplastic/pre-invasive cancerous phase for HPV+ oropharyngeal cancers, and analogous with other HPV+ cancers. This raises the possibility of strategies for cancer screening as early diagnosis will undoubtedly save lives. Summary Staging and prognostication have changed to take into account the distinct biological and prognostic pathways for viral+ and viral− cancers. Diagnosis of pre-cancers and early stage cancers will reduce mortality rates. Multi-modal treatment options for HNSCC are reviewed, especially recent developments with immunotherapies and precision medicine strategies. Knowledge integration of the viral and molecular oncogenic pathways with sound planning, hypothesis generation, and clinical trials will continue to provide therapeutic options in the future.
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Nemesio I, Cury F, Longatto-Filho A, Fregnani JH, Musselwhite L, Vazquez F, Peters AC, Oliveira C. Identification of human papillomavirus in oral rinse specimens from women with and without cervical intraepithelial lesions. Sex Transm Infect 2020; 96:408-410. [DOI: 10.1136/sextrans-2019-054359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/14/2020] [Accepted: 01/28/2020] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe objective of this study was to evaluate the frequency of human papillomavirus (HPV) in the oral cavity of women with and without abnormal cervical cytology and to determine whether there is an association of oral HPV infection with infection of the cervix or with cervical cancer precursor lesions.MethodsThe present study was conducted among 406 women, aged 18–82 years, who attended the Prevention Department of Barretos Cancer Hospital (HCB), Brazil due to a previous altered cervical cytology result. Oral rinse, cervical cytology and biopsy were collected at the same day. The participants also answered a questionnaire about socioeconomic characteristics and risk factors for cervical cancer. Molecular screening for HPV16, HPV18 and 12 other high-risk HPV types was performed on cervical and oral rinse specimens using Cobas 4800 (Roche Molecular Systems, USA).ResultsHPV was detected in the oral rinse of 3.9% of participants. Infection of the oral cavity with a non-HPV16 or 18 type was most frequent (81.2%), followed by HPV16 (18.7%). Infection with HPV in the cervix and oral cavity was present in 11 (2.7%) of participants. There were no differences observed in the smoking status (p value 0.62), mean age of first sexual intercourse (p value 0.25), mean age of the first oral sex (p value 0.90) or mean lifetime number of sexual partners (p value 0.08) between the participants with oral HPV infection or not.ConclusionThe presence of HPV infection in the oral cavity was low in the group of women with abnormal cervical cancer screening findings and a high rate of cervical HPV infection.
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Howard J, Dwivedi RC, Masterson L, Kothari P, Quon H, Holsinger FC. De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. Cochrane Database Syst Rev 2018; 12:CD012939. [PMID: 30550641 PMCID: PMC6517188 DOI: 10.1002/14651858.cd012939.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell cancer (OPSCC) are diagnosed every year worldwide and this is rising. Much of the increase has been attributed to human papillomavirus (HPV). HPV-positive OPSCC patients are often younger and have significantly improved survival relative to HPV-negative patients. Traditional management of OPSCC has been with radiotherapy with or without chemotherapy, as this was shown to have similar survival to open surgery but with significantly lower morbidity. Techniques have evolved, however, with the development of computerised planning and intensity-modulated radiotherapy, and of minimally invasive surgical techniques. Acute and late toxicities associated with chemoradiotherapy are a significant burden for OPSCC patients and with an ever-younger cohort, any strategies that could decrease treatment-associated morbidity should be investigated. OBJECTIVES To assess the effects of de-intensified adjuvant (chemo)radiotherapy in comparison to standard adjuvant (chemo)radiotherapy in patients treated with minimally invasive transoral surgery (transoral robotic surgery or transoral laser microsurgery) for resectable HPV-positive oropharyngeal squamous cell carcinoma. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 26 April 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) in patients with carcinoma of the oropharynx (as defined by the World Health Organization classification C09, C10). Cancers included were primary HPV-positive squamous cell tumours originating from the oropharyngeal mucosa. Tumours were classified as T1-4a with or without nodal spread and with no evidence of distant metastatic spread. The intervention was minimally invasive transoral surgery followed by de-intensified adjuvant therapy (either omission of chemotherapy or reduced-dose radiotherapy). The comparator was minimally invasive transoral surgery followed by standard concurrent chemoradiotherapy or standard-dose radiotherapy. The treatments received were of curative intent and patients had not undergone any prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related survival was to be studied where possible) and disease-free survival, measured at one, two, three and five years. Our secondary outcomes included assessment of swallowing ability and voice, measured at one, six, 12 and 24 months. We planned to use GRADE to assess the quality of evidence for each outcome. MAIN RESULTS We did not identify any completed RCTs that met our inclusion criteria. However, three eligible studies are in progress:ADEPT is a phase III trial comparing postoperative radiotherapy with or without cisplatin in HPV-positive T1-4a OPSCC patients. Included patients must have received minimally invasive surgery and demonstrated extra-capsular spread from disease in the neck.ECOG-E3311 is a phase II trial of treatment for HPV-positive locally advanced OPSCC (stages III-IVa + IVb without distant metastasis). Patients are stratified after minimally invasive surgery. Medium-risk patients are randomised to either standard or reduced-dose radiotherapy.PATHOS is a phase III trial of treatment for HPV-positive OPSCC (T1-3, N0-2b). Patients are stratified after minimally invasive surgery. Medium-risk patients are randomised to either standard or reduced-dose radiotherapy. High-risk patients are randomised to radiotherapy with or without concurrent cisplatin. AUTHORS' CONCLUSIONS This review highlights the current lack of high-quality randomised controlled trials studying treatment de-escalation after minimally invasive surgery in patients with HPV-positive OPSCC. However, trials that will meet the inclusion criteria for this review are in progress with results expected between 2021 and 2023.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Harry Quon
- Sidney Kimmel Comprehensive Cancer CenterDepartment of Radiation Oncology and Molecular Radiation Sciences401 North Broadway‐Suite 1440BaltimoreUSA
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Human papillomavirus (HPV) and its vaccine: awareness and opinions of clinical dental students in a UK dental school. Br Dent J 2018; 225:976-981. [DOI: 10.1038/sj.bdj.2018.1024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/08/2022]
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Szyfter K, Napierala M, Florek E, Braakhuis BJM, Takes RP, Rodrigo JP, Rinaldo A, Silver CE, Ferlito A. Molecular and health effects in the upper respiratory tract associated with tobacco smoking other than cigarettes. Int J Cancer 2018; 144:2635-2643. [DOI: 10.1002/ijc.31846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/14/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | - Marta Napierala
- Laboratory of Environmental Research, Department of ToxicologyPoznan University of Medical Sciences Poznan Poland
| | - Ewa Florek
- Laboratory of Environmental Research, Department of ToxicologyPoznan University of Medical Sciences Poznan Poland
| | | | - Robert P. Takes
- International Head & Neck Scientific Group Padua Italy
- Department of Otolaryngology‐Head and Neck Surgery, Radboud University Medical CentreRadboud Institute for Health Sciences Nijmegen the Netherlands
| | - Juan P. Rodrigo
- International Head & Neck Scientific Group Padua Italy
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPAUniversity of Oviedo, CIBERONC Oviedo Spain
| | - Alessandra Rinaldo
- International Head & Neck Scientific Group Padua Italy
- Department of OtolaryngologyUniversity of Udine School of Medicine Udine Italy
| | - Carl E. Silver
- International Head & Neck Scientific Group Padua Italy
- Department of SurgeryUniversity of Arizona College of Medicine Phoenix AZ
| | - Alfio Ferlito
- Coordinator of the International Head & Neck Scientific Group Padua Italy
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Jamieson L, Garvey G, Hedges J, Mitchell A, Dunbar T, Leane C, Hill I, Warren K, Brown A, Ju X, Roder D, Logan R, Johnson N, Smith M, Antonsson A, Canfell K. Human Papillomavirus and Oropharyngeal Cancer Among Indigenous Australians: Protocol for a Prevalence Study of Oral-Related Human Papillomavirus and Cost-Effectiveness of Prevention. JMIR Res Protoc 2018; 7:e10503. [PMID: 29884604 PMCID: PMC6015268 DOI: 10.2196/10503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Oropharyngeal cancer is an important, understudied cancer affecting Aboriginal and Torres Strait Islander Australians. The human papillomavirus (HPV) is a significant risk factor for oropharyngeal cancer. Current generation HPV vaccines are effective against the 2 most common types of high-risk HPVs in cancer (hrHPVs 16/18). Objectives This study aims (1) to yield population estimates of oncogenic genotypes of HPV in the mouth and oropharynx of defined Aboriginal and Torres Strait Islander populations; (2) to estimate the proportion of oropharyngeal cancer attributable to HPV among these Australian citizens; (3) to estimate the impact of HPV vaccination as currently implemented on rates of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians; and (4) taking into account impact on oropharyngeal as well as cervical cancer, to evaluate efficacy and cost-effectiveness of targeted extended HPV vaccination to older ages, among our study population. Methods Our study design and operation is straightforward, with minimal impost on participants. It involves testing for carriage of hrHPV in the mouth and oropharynx among 1000 Aboriginal South Australians by simple saliva collection and with follow-up at 12 and 24 months, collection of sexual history at baseline, collection of information for estimating health state (quality-of-life) utilities at baseline, genotyping of viruses, predictive outcome and cost-effectiveness modeling, data interpretation and development of vaccination, and follow-up management strategies driven by the Aboriginal community. Results Participant recruitment for this study commenced in February 2018 and enrollment is ongoing. The first results are expected to be submitted for publication in 2019. Conclusions The project will have a number of important outcomes. Synthesis of evidence will enable generation of estimates of the burden of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians and indicate the likely effectiveness and cost-effectiveness of prevention. This will be important for health services planning, and for Aboriginal health worker and patient education. The results will also point to important areas where research efforts should be focused to improve outcomes in Aboriginal and Torres Strait Islander Australians with oropharyngeal cancer. There will be a strong focus on community engagement and accounting for the preferences of individuals and the community in control of HPV-related cancers. The project has international relevance in that it will be the first to systematically evaluate prevention of both cervical and oropharyngeal cancer in a high-risk Indigenous population taking into account all population, testing, and surveillance options. Registered Report Identifier RR1-10.2196/10503
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Affiliation(s)
- Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Amanda Mitchell
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Terry Dunbar
- Yaitya Purruna Indigenous Health Unit, University of Adelaide, Adelaide, Australia
| | - Cathy Leane
- Aboriginal Health Division Women's and Children's Health Network, Adelaide, Australia
| | - Isaac Hill
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Kate Warren
- Pika Wiya Health Service Inc, Port Augusta, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - David Roder
- School of Health Sciences, Univesity of South Australia, Adelaide, Australia
| | - Richard Logan
- Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Newell Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Megan Smith
- Cancer Council of New South Wales, Sydney, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Karen Canfell
- Cancer Council of New South Wales, Sydney, Australia
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Howard J, Dwivedi RC, Masterson L, Kothari P, Quon H, Holsinger FC. De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. Hippokratia 2018. [DOI: 10.1002/14651858.cd012939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation Trust; ENT Department; Hills Road Cambridge UK CB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation Trust; ENT Department; Hills Road Cambridge UK CB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation Trust; ENT Department; Hills Road Cambridge UK CB2 0QQ
| | | | - Harry Quon
- Sidney Kimmel Comprehensive Cancer Center; Department of Radiation Oncology and Molecular Radiation Sciences; 401 North Broadway-Suite 1440 Baltimore USA
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Josiassen MV, Charabi B, Lajer CB, Garnaes E, Hamilton Therkildsen M, Norrild B, Specht L, Nielsen FC, von Buchwald C. Correlation between HPV status at T and N sites of oropharyngeal squamous cell carcinomas. Acta Otolaryngol 2017; 137:1260-1264. [PMID: 28758552 DOI: 10.1080/00016489.2017.1356934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Human papilloma virus (HPV) is known to be associated with oropharyngeal squamous cell carcinomas (OPSCC) and may potentially play a vital role in tumor metastasis. The purpose of this study was to correlate HPV status of cervical lymph node metastases with their respective primary OPSCC tumor. METHODS Formalin-fixed, paraffin-embedded (FFPE) tissue samples obtained from 34 patients with cervical lymph node metastases were analyzed with HPV 16 DNA polymerase chain reaction (PCR), p16 immunohistochemistry and HPV typing. The results were correlated with the HPV status and type found in the primary tumors of OPSCC. RESULTS Comparing HPV DNA status with p16 we found that 21 primary tumors and lymph node metastases were HPV positive (61.8%) and seven primary tumors and lymph node metastases were HPV negative (20.6%). Six patient samples differed when correlating the primary tumor and lymph node metastasis (17.6%). CONCLUSIONS In this study, HPV status in OPSCCs and their cervical lymph node metastases correlated in the vast majority of cases. However, HPV detection methods may have certain limitations resulting in varying degree of non-correlation. This should be taken into account when stratifying treatment in regard to HPV status.
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Affiliation(s)
- Michael Vallop Josiassen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christel Braemer Lajer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Garnaes
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Bodil Norrild
- Department of Cellular and Molecular Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Genomic Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Kin Cho Goon P, Scholtz LU, Sudhoff H. Recurrent respiratory papillomatosis (RRP)-time for a reckoning? Laryngoscope Investig Otolaryngol 2017; 2:184-186. [PMID: 28894838 PMCID: PMC5562946 DOI: 10.1002/lio2.80] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/13/2016] [Accepted: 03/14/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives Recurrent respiratory papillomatosis (RRP) is a rare disease, but one with severe morbidity and occasional mortality. The aetiological agent is human papillomavirus (HPV), and HPV types 6 and 11 account for over 90% of all cases. In the active phase of the disease, patients require multiple hospital admissions for surgical removal or ablation of these benign tumors, which are likely to obstruct the airways if left unchecked. Long‐term sequelae include scarring of the vocal cords, change in voice timbre, or even muteness if a tracheostomy is required. The aim of this study was to determine if adjuvant vaccination with the quadrivalent HPV L1 vaccine (Gardasil™) would decrease numbers of surgical treatments post‐vaccination. Methods A prospective pilot study following a cohort of 12 RRP patients, all of whom gave fully informed consent to participate. All patients had their papillomas typed and if they were found to have types 6 or 11, were vaccinated at the time of first surgical treatment in the hospital, according to the manufacturer's protocols. Patients were followed up closely with 3 or 6 month follow‐up visits. Standard surgical treatments were given and were not affected by whether they participated in the study. Results We found a >7‐fold decrease in the incidence rates of papillomatosis requiring surgical intervention from the pre‐vaccination period (47.44/1000 patient‐months) compared to the post‐vaccination period (6.71/1000 patient‐months). Discussion Surgical treatments for RRP are robust markers for papillomata which require treatment because of the dangers of obstruction of the airway. Despite the small size of this cohort (due to the rarity of this disease), the data suggests that adjuvant use of quadrivalent HPV L1 vaccine imparts significant benefit to this group of patients. A large multi‐center randomized placebo controlled trial is required to definitively establish whether this hypothesis is true and can become the new standard of therapy. Level of Evidence 3b
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Affiliation(s)
- Peter Kin Cho Goon
- Department of Dermatology (P.K.C.G.) Norfolk and Norwich University Hospital Colney Lane Norwich UK
| | - Lars-Uwe Scholtz
- Department of Ear, Nose and Throat Surgery (L.-U.S., H.S.) Bielefeld Germany
| | - Holger Sudhoff
- Department of Ear, Nose and Throat Surgery (L.-U.S., H.S.) Bielefeld Germany
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Albano PM, Holzinger D, Salvador C, Orosa J, Racelis S, Leaño M, Sanchez D, Angeles LM, Halec G, Schmitt M, Ramos JD, Pawlita M. Low prevalence of human papillomavirus in head and neck squamous cell carcinoma in the northwest region of the Philippines. PLoS One 2017; 12:e0172240. [PMID: 28199413 PMCID: PMC5310881 DOI: 10.1371/journal.pone.0172240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Geographic heterogeneity of human papillomavirus (HPV) involvement in head and neck squamous cell carcinoma (HNSCC) has been observed over the last few years. This trend has not been evaluated in the Philippines. Hence, this study aims to provide for the first time a data on the prevalence of HPV in HNSCC in the northwestern region of the Philippines. METHODS Two hundred one (201) biopsy samples (179 formalin fixed paraffin embedded and 22 fresh frozen) from 163 Filipino HNSCC cases (oral cavity = 88; larynx = 60; oropharynx = 15) diagnosed between 2003 to 2013 were initially included in this study. HPV DNA was detected by two methods: (1) BSGP5+/6+-PCR/ multiplex human papillomavirus genotyping and (2) TaqMan probes-based real-time qPCR. Presence of HPV type-specific transcripts were also analyzed by reverse transcription-PCR with subsequent hybridization to oligonucleotide probes coupled to Luminex beads. Co-amplification of the β-globin and ubiquitin C genes served as internal positive controls for DNA and RNA analyses, respectively. RESULTS AND CONCLUSIONS Of the 163, 82 (50.3%) cases had at least one tissue sample that was valid for molecular analysis. Only two of the DNA valid cases (2.4%) were HPV DNA-positive (HPV11 and HPV33). All HPV mRNA assays rendered negative results except for HPV11 transcripts. Results of this study may indicate that there is probably very low prevalence of HPV-associated HNSCC among Filipino adults living in a rural region of the Philippines. This study could serve as a benchmark for designing follow-up studies that would assess possible changes in trends of HNSCC among Filipinos in different ethnic regions of the country, especially urban areas in which the population is expected to adapt Western style sexual behavior. A prospective sampling of fresh frozen tissue is also highly recommended to ensure better molecular analyses.
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Affiliation(s)
- Pia Marie Albano
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Biology, College of Science, University of Santo Tomas, Manila, Philippines
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christianne Salvador
- Deparment of ENT Head and Neck Surgery, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Jose Orosa
- Deparment of ENT Head and Neck Surgery, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Sheryl Racelis
- Department of Pathology and Laboratories, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Modesty Leaño
- Department of Pathology and Laboratories, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Danilo Sanchez
- Deparment of ENT Head and Neck Surgery, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Lara Mae Angeles
- Department of Clinical Pathology, University of Santo Tomas Hospital, Manila, Philippines
| | - Gordana Halec
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Schmitt
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - John Donnie Ramos
- Department of Biology, College of Science, University of Santo Tomas, Manila, Philippines
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Howard J, Masterson L, Dwivedi RC, Riffat F, Benson R, Jefferies S, Jani P, Tysome JR, Nutting C. Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma. Cochrane Database Syst Rev 2016; 12:CD010963. [PMID: 27943254 PMCID: PMC6463943 DOI: 10.1002/14651858.cd010963.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important. OBJECTIVES To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016. SELECTION CRITERIA Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score. MAIN RESULTS No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016. AUTHORS' CONCLUSIONS The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Chris Nutting
- Royal Marsden HospitalHead and Neck UnitFulham RoadLondonUKSW3 6JJ
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13
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Flowers SA, Zhou X, Wu J, Wang Y, Makambi K, Kallakury BV, Singer MS, Rosen SD, Davidson B, Goldman R. Expression of the extracellular sulfatase SULF2 is associated with squamous cell carcinoma of the head and neck. Oncotarget 2016; 7:43177-43187. [PMID: 27223083 PMCID: PMC5190016 DOI: 10.18632/oncotarget.9506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/16/2016] [Indexed: 12/15/2022] Open
Abstract
Sulfatase 2 (SULF2), an extracellular sulfatase that alters sulfation on heparan sulfate proteoglycans, is involved in the tumorigenesis and progression of several carcinomas. SULF2 expression has not been evaluated in squamous cell carcinoma of the head and neck (HNSCC). Here we report results of IHC of SULF2 expression in HNSCC tissue. SULF2 was detected in 57% of tumors (n = 40) with a significant increase in intensity and number of stained cells compared to adjacent cancer-free tissue (p-value < 0.01), increasing with cancer stage when comparing stages 1 and 2 to stages 3 and 4 (p-value 0.01). SULF2 was not detected in epithelial cells of cancer-free controls, and expression was independent of patient demographics, tumor location and etiological factors, smoking and HPV infection by p16 IHC analysis. Sandwich ELISA was performed on serum of HNSCC patients (n = 28) and controls (n = 35), and although SULF2 was detectable, no change was observed in HNSCC. Saliva, collected by mouthwash, from HNSCC patients (n = 8) and controls (n = 8) was also tested by ELISA in a preliminary investigation and an increase in SULF2 was observed in HNSCC (p-value 0.041). Overall, this study shows that SULF2 is increased in HNSCC independent of tissue location (oral cavity, oropharynx, larynx and hypopharynx), patient demographics and etiology. Although no change in SULF2 was detected in HNSCC serum, its detection in saliva makes it worthy of further investigation as a potential HNSCC biomarker.
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Affiliation(s)
- Sarah A. Flowers
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Xin Zhou
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Jing Wu
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Yiwen Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Kepher Makambi
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Bhaskar V. Kallakury
- Department of Pathology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mark S. Singer
- Department of Anatomy, University of California, San Francisco, CA 94143, USA
| | - Steven D. Rosen
- Department of Anatomy, University of California, San Francisco, CA 94143, USA
| | - Bruce Davidson
- Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC 20057, USA
| | - Radoslav Goldman
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington, DC 20057, USA
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14
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Joh J, Ghim SJ, Chilton PM, Sundberg JP, Park J, Wilcher SA, Proctor ML, Bennett Jenson A. MmuPV1 infection and tumor development of T cell-deficient mice is prevented by passively transferred hyperimmune sera from normal congenic mice immunized with MmuPV1 virus-like particles (VLPs). Exp Mol Pathol 2016; 100:212-9. [PMID: 26778691 DOI: 10.1016/j.yexmp.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 12/28/2022]
Abstract
Infection by mouse papillomavirus (PV), MmuPV1, of T cell-deficient, B6.Cg-Foxn1(nu)/J nude mice revealed that four, distinct squamous papilloma phenotypes developed simultaneously after infection of experimental mice. Papillomas appeared on the muzzle, vagina, and tail at or about day 42days post-inoculation. The dorsal skin developed papillomas and hair follicle tumors (trichoblastomas) as early as 26days after infection. Passive transfer of hyperimmune sera from normal congenic mice immunized with MmuPV1 virus-like particles (VLPs) to T cell-deficient strains of mice prevented infection by virions of experimental mice. This study provides further evidence that T cell deficiency is critical for tumor formation by MmuPV1 infection.
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Affiliation(s)
- Joongho Joh
- James Graham Brown Cancer Center, 505 South Hancock Street, Louisville, KY, United States; Department of Medicine, 550 South Jackson Street, Louisville, KY, United States.
| | - Shin-je Ghim
- James Graham Brown Cancer Center, 505 South Hancock Street, Louisville, KY, United States
| | - Paula M Chilton
- Christine M. Kleinert Institute for Hand & Microsurgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY, United States
| | | | - Jino Park
- James Graham Brown Cancer Center, 505 South Hancock Street, Louisville, KY, United States
| | - Sarah A Wilcher
- Research Resources Center, 530 South Jackson Street, Louisville, KY, United States
| | - Mary L Proctor
- Research Resources Center, 530 South Jackson Street, Louisville, KY, United States
| | - A Bennett Jenson
- James Graham Brown Cancer Center, 505 South Hancock Street, Louisville, KY, United States
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15
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Eriksen JG, Lassen P. Human Papilloma Virus as a Biomarker for Personalized Head and Neck Cancer Radiotherapy. Recent Results Cancer Res 2016; 198:143-61. [PMID: 27318685 DOI: 10.1007/978-3-662-49651-0_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A dramatic increase in the incidence of HPV-related oropharyngeal cancer has been reported in some parts of the western world over the past 30 years. They constitute a clinically distinct subgroup of cancers in terms of molecular biology, patient characteristics, and treatment outcome. This chapter describes the molecular characteristics, epidemiology, and demographics of the HPV-related head and neck cancers and discuss available methods to detect HPV-related tumours. The impact of HPV-related biomarkers in clinical studies on radiotherapy only, altered fractionation, modulation of hypoxia, and concurrent chemo- or bio-radiotherapy are reviewed as well as the perspectives of de-escalation and immune-modulation are discussed.
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Affiliation(s)
| | - Pernille Lassen
- Department of Oncology, Department of Clinical Experimental Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
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16
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Hybrid Capture 2 is as effective as PCR testing for high-risk human papillomavirus in head and neck cancers. Appl Immunohistochem Mol Morphol 2015; 23:266-72. [PMID: 25839700 DOI: 10.1097/pdm.0000000000000036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
High-risk human papillomavirus (HPV) infection is a common cause of oropharyngeal squamous cell carcinoma, especially in young male nonsmokers. Accurately diagnosing HPV-associated oral cancers is important, because they have a better prognosis and may be treated differently than smoking-related oral carcinomas. Various methods have been validated to test for high-risk HPV in cervical tissue samples, and they are in routine clinical use to detect dysplasia before it progresses to invasive disease. Similarly, future screening for HPV-mediated oropharyngeal dysplasia may identify patients before it progresses. Our objective was to compare 4 of these methods in a retrospective series of 87 oral and oropharyngeal squamous cell carcinomas that had archived fresh-frozen and paraffin-embedded tissue for evaluation. Patient age, sex, smoking history, and tumor location were also recorded. DNA prepared from fresh-frozen tissue was tested for HPV genotypes by multiplex polymerase chain reaction analysis, and high-risk HPV screening was carried out using Hybrid Capture 2 and Cervista. Histologic sections were immunostained for p16. HPV-positive outcome was defined as agreement between at least 2 of the 3 genetic tests and used for χ analysis and calculations of diagnostic predictive value. As expected, high-risk HPV-positive oral cancers were most common in the tonsil and base of the tongue (oropharynx) of younger male (55 vs. 65 y) (P=0.0002) nonsmokers (P=0.01). Most positive cases were HPV16 (33/36, 92%). Hybrid Capture 2 and Cervista were as sensitive as polymerase chain reaction and had fewer false positives than p16 immunohistochemical staining.
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17
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Samuels SE, Eisbruch A, Beitler JJ, Corry J, Bradford CR, Saba NF, van den Brekel MWM, Smee R, Strojan P, Suárez C, Mendenhall WM, Takes RP, Rodrigo JP, Haigentz M, Rapidis AD, Rinaldo A, Ferlito A. Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we? Eur Arch Otorhinolaryngol 2015; 273:2877-94. [PMID: 26463714 DOI: 10.1007/s00405-015-3771-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
Abstract
HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - June Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Missak Haigentz
- Division of Oncology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alexander D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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18
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Masterson L, Moualed D, Liu ZW, Howard JEF, Dwivedi RC, Tysome JR, Benson R, Sterling JC, Sudhoff H, Jani P, Goon PKC. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials. Eur J Cancer 2014; 50:2636-48. [PMID: 25091798 DOI: 10.1016/j.ejca.2014.07.001] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022]
Abstract
Iatrogenic complications associated with current treatment protocols for oropharyngeal squamous cell carcinoma are noted to cause high rates of acute and chronic morbidity. The aims of this study are to provide an overview of the current de-escalation trials for human papillomavirus positive (HPV+) oropharyngeal carcinoma and to evaluate the evidence supporting improved response to treatment of patients within this viral cohort. This study reviewed all completed or in progress randomised controlled trials (RCTs) assessing clinical interventions for human papillomavirus-associated locally advanced oropharyngeal squamous cell carcinoma. We utilised a validated 'risk of bias' tool to assess study quality. We identified nine RCTs that met the full inclusion criteria for this review (all of which are currently on-going and will report from 2015 onwards). Five RCTs performed a post hoc analysis by HPV status, which allowed meta-analysis of 1130 patients. The data reveal a significant difference in overall survival (hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.35-0.69]), loco-regional failure (HR 0.43 [95% CI 0.17-1.11]) and disease specific survival (0.41 [95% 0.3-0.56]) in favour of the HPV+ category. In considering de-escalation treatment protocols, nine studies are currently ongoing. Our meta-analysis provides strong evidence for an improved prognosis in the viral associated cohort when treated by platinum based chemotherapy in combination with radiotherapy or primary radiotherapy. So far, one trial (with moderate to high risk of bias) suggests a reduced survival outcome for the HPV+ population when using the epidermal growth factor receptor (EGFR) inhibitor cetuximab.
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Affiliation(s)
- Liam Masterson
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, University of Cambridge, UK.
| | - Daniel Moualed
- ENT Department, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Zi Wei Liu
- ENT Department, Barts Health NHS Trust, London, UK
| | - James E F Howard
- Oncology Centre, University College Hospital NHS Trust, London, UK
| | - Raghav C Dwivedi
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James R Tysome
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, Bielefeld, Germany
| | - Piyush Jani
- ENT Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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19
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Jalilvand S, Shoja Z, Hamkar R. Human Papillomavirus Burden in Different Cancers in Iran: a Systematic Assessment. Asian Pac J Cancer Prev 2014; 15:7029-35. [DOI: 10.7314/apjcp.2014.15.17.7029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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UMBREIT CLAUDIA, ADERHOLD CHRISTOPH, FABER ANNE, SAUTER ALEXANDER, HOFHEINZ RALFDIETER, STERN-STRAETER JENS, HOERMANN KARL, SCHULTZ JOHANNESDAVID. Imatinib-associated matrix metalloproteinase suppression in p16-positive squamous cell carcinoma compared to HPV-negative HNSCC cells in vitro. Oncol Rep 2014; 32:668-76. [DOI: 10.3892/or.2014.3225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/13/2014] [Indexed: 11/06/2022] Open
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21
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The Role of Protein p16INK4a in Glottic Laryngeal Squamous Cell Carcinoma. Pathol Oncol Res 2014; 20:909-15. [DOI: 10.1007/s12253-014-9773-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
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22
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Psychogios G, Alexiou C, Agaimy A, Brunner K, Koch M, Mantsopoulos K, Tomppert A, Iro H. Epidemiology and survival of HPV-related tonsillar carcinoma. Cancer Med 2014; 3:652-9. [PMID: 24616325 PMCID: PMC4101756 DOI: 10.1002/cam4.212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/16/2013] [Accepted: 01/06/2014] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to determine the proportion of human papilloma virus (HPV)-positive cases in tonsillar carcinomas and investigate its development over the last decade. Further aim was to show the oncologic results in accord to HPV status and various treatment modalities. A retrospective study was conducted between 2000 and 2012 and included 275 patients treated for tonsillar carcinoma. P16 immunohistochemistry was used as a surrogate marker for HPV-associated carcinogenesis. A total of 101 (36.7%) patients proved to be p16 positive and 174 p16 negative. 80.2% of the p16-positive cases presented with T1-2 tumor. Of the early-stage patients, 79% of the p16-positive and 52.3% of the p16-negative presented with lymph node metastases. The percentage of p16-positive patients increased from 23.2% in the period 2005–2007 to 58.6% in the period 2010–2012 in the whole population and from 30.9% to 76.9% in T1-2 carcinomas. Early T-category p16-positive carcinomas had significantly better disease-specific survival (92.4% vs. 75.5%, P = 0.007) and overall survival (OS, 79.6% vs. 54.3%, P < 0.001) compared to p16-negative tumors. This study showed an increase in the percentage of p16-positive patients in tonsillar carcinoma from 23.2% in the years between 2005 and 2007 to 58.6% between 2010 and 2012. The majority (80.2%) of p16-positive patients presented with early T-category tumor but most of these (79.0%) had also lymph node metastases. Nevertheless, p16-positive patients had excellent oncologic results after surgery and adjuvant radiotherapy and could be considered for de-escalation of treatment.
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Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 1, Erlangen, 91054, Germany
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23
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Masterson L, Moualed D, Masood A, Dwivedi RC, Benson R, Sterling JC, Rhodes KM, Sudhoff H, Jani P, Goon P. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cochrane Database Syst Rev 2014; 2014:CD010271. [PMID: 24532092 PMCID: PMC10654373 DOI: 10.1002/14651858.cd010271.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human papillomavirus-associated oropharyngeal squamous cell carcinomas are a distinct subgroup of tumours that may have a better prognosis than traditional tobacco/alcohol-related disease. Iatrogenic complications, associated with conventional practice, are estimated to cause mortality of approximately 2% and high morbidity. As a result, clinicians are actively investigating the de-escalation of treatment protocols for disease with a proven viral aetiology. OBJECTIVES To summarise the available evidence regarding de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal squamous cell carcinoma. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 25 June 2013. SELECTION CRITERIA Randomised controlled trials investigating de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal carcinoma. Specific de-escalation categories were: 1) bioradiotherapy (experimental) versus chemoradiotherapy (control); 2) radiotherapy (experimental) versus chemoradiotherapy (control); and 3) low-dose (experimental) versus standard-dose radiotherapy (control). The outcomes of interest were overall and disease-specific survival, treatment-related morbidity, quality of life and cost. DATA COLLECTION AND ANALYSIS Three authors independently selected studies from the search results and extracted data. We planned to use the Cochrane 'Risk of bias' tool to assess study quality. MAIN RESULTS We did not identify any completed randomised controlled trials that could be included in the current version of this systematic review. We did, however, identify seven ongoing trials that will meet our inclusion criteria. These studies will report from 2014 onwards. We excluded 30 studies on methodological grounds (seven randomised trials with post hoc analysis by human papillomavirus status, 11 prospective trials and 12 ongoing studies). AUTHORS' CONCLUSIONS There is currently insufficient high-quality evidence for, or against, de-escalation of treatment for human papillomavirus-associated oropharyngeal carcinoma. Future trials should be multicentre to ensure adequate power. Adverse events, morbidity associated with treatment, quality of life outcomes and cost analyses should be reported in a standard format to facilitate comparison with other studies.
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Affiliation(s)
- Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Daniel Moualed
- Great Western Hospitals NHS Foundation TrustENT DepartmentSwindonUK
| | - Ajmal Masood
- Norfolk and Norwich University HospitalENT DepartmentNorwichUK
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Jane C Sterling
- Addenbrooke's HospitalDepartment of DermatologyBox 46CambridgeUKCB2 2QQ
| | - Kirsty M Rhodes
- University of CambridgeMRC Biostatistics UnitNewnham CollegeSidgwick AvenueCambridgeCambridgeshireUKCB3 DF
| | - Holger Sudhoff
- Bielefeld Academic Teaching HospitalDepartment of Otolaryngology, Head and Neck SurgeryTeutoburger Str. 50BielefeldGermany33604
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentCambridgeUKCB2 0QQ
| | - Peter Goon
- University of CambridgeDepartment of PathologyCambridgeUK
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24
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Joh J, Jenson AB, Ingle A, Sundberg JP, Ghim SJ. Searching for the initiating site of the major capsid protein to generate virus-like particles for a novel laboratory mouse papillomavirus. Exp Mol Pathol 2014; 96:155-61. [PMID: 24389228 DOI: 10.1016/j.yexmp.2013.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
Correctly folded virus-like particles (VLPs) of papillomavirus (PV) display conformationally dependent epitopes that are type specific, maintained on authentic virions, and induce neutralizing antibodies. Alignment of the L1 amino acid (aa) sequences of 84 PVs revealed that the lengths of their N-termini are diverse and that multiple, possible initiation methionine (met) codons exist. The L1 gene of MusPV (MmuPV1), that naturally infects immunodeficient laboratory mouse strain (NMRI-Foxn1(nu)/Foxn1(nu)), has four met codons at the 1st, 2nd, 28th, and 30th aas from its N-terminus. Of these, the 3rd and 4th mets, that are at the 28th and 30th aa position from the N-termius, respectively, are located at the position where most PVs have their first met. These two mets, located at the 9th and 11th from the YLPP conserved aas of most PVs, should be considered as consensus initiation codons of PV L1s. Three L1 proteins of MusPV, starting from the 2nd, 3rd, and 4th mets, were expressed using a baculovirus expression system and characterized for their ability to self-assemble into VLPs. While MusPV L1 proteins starting from the 2nd met expressed an L1 protein that did not fold into VLPs, the L1s starting from the 3rd and 4th mets generated correct VLPs in abundant quantities. We now conclude that the highest quantity and best quality VLPs are made from the consensus L1 met of MusPV.
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Affiliation(s)
- Joongho Joh
- Department of Medicine, James Graham Brown Cancer Center (JGBCC), University of Louisville, Louisville, KY, United States
| | - Alfred B Jenson
- Department of Medicine, James Graham Brown Cancer Center (JGBCC), University of Louisville, Louisville, KY, United States
| | - Arvind Ingle
- Tata Memorial Centre, ACTREC, Kharghar, Navi Mumbai 410-210, India
| | | | - Shin-je Ghim
- Department of Medicine, James Graham Brown Cancer Center (JGBCC), University of Louisville, Louisville, KY, United States.
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25
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HPV positive tonsillar cancer in two laser surgeons: case reports. J Otolaryngol Head Neck Surg 2013; 42:54. [PMID: 24246045 PMCID: PMC3843579 DOI: 10.1186/1916-0216-42-54] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 11/14/2013] [Indexed: 01/09/2023] Open
Abstract
A 53 year-old male gynecologist presented with human papillomavirus (HPV) 16 positive tonsillar squamous cell carcinoma. He had no identifiable risk factors with the exception of long term occupational exposure to laser plumes, having performed laser ablations and loop electrosurgical excision procedures (LEEP) on greater than 3000 dysplastic cervical and vulvar lesions over 20 years of practice. The second patient is a 62 year old male gynecologist with a 30 year history of laser ablation and LEEP who subsequently developed HPV 16 positive base of tongue cancer. He also had very few other risk factors for oropharyngeal cancer or HPV infection. HPV is a probable causative agent for oropharyngeal squamous cell carcinoma and has been reported as being transmittable through laser plume. This paper suggests that HPV transmitted through laser plume can result in subsequent squamous cell carcinoma.
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26
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Affiliation(s)
- Pernille Lassen
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus C, Denmark
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27
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Gillison ML, Alemany L, Snijders PJF, Chaturvedi A, Steinberg BM, Schwartz S, Castellsagué X. Human papillomavirus and diseases of the upper airway: head and neck cancer and respiratory papillomatosis. Vaccine 2013. [PMID: 23199965 DOI: 10.1016/j.vaccine.2012.05.070] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Human papillomavirus (HPV) infection is causally associated with benign and malignant diseases of the upper airway, including respiratory papillomatosis and oropharyngeal cancer. Low-risk HPV types 6 and 11 are the predominant cause of papillomatosis, whereas only HPV16 definitively satisfies both molecular and epidemiological causal criteria as a carcinogenic or high-risk type in the upper airway. HPV16 E6/E7 mRNA expression and integration are observed predominantly among oropharyngeal cancers, and experimental models have shown E6/E7 expression to be necessary for the initiation and maintenance of the malignant phenotype of these cancers. From an epidemiological perspective, a strong and consistent association between markers of HPV16 exposure and oropharyngeal cancer has been demonstrated in numerous case-control studies. HPV-positive oropharyngeal cancers have also been shown to be distinct from HPV-negative head and neck squamous cell cancers with regard to risk-factor profiles, molecular genetic alterations, population-level incidence trends over time, and prognosis. Tumor HPV status (as determined by certain HPV16 in situ hybridization assays or certain p16 immunohistochemistry assays) is the strongest determinant of survival for patients with local-regionally advanced oropharyngeal cancer: patients with HPV-positive cancer have at least a 50% improvement in overall survival at 5 years, which is equivalent to an approximate 30% difference in absolute survival. Thus, HPV status determination is now part of the routine diagnostic evaluation for prognostication. Preliminary evidence indicates that a small proportion of head and neck cancers may be caused by additional HPV types (e.g., 18, 31, 33, 35) and that HPV-caused cancers may rarely arise from non-oropharyngeal sites (e.g., the oral cavity, nasopharynx, and larynx). Whether or not HPV vaccination has the potential to prevent oral HPV infections that lead to cancer or papillomatosis in the upper airway is currently unknown, as is the potential for secondary prevention with HPV detection. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Maura L Gillison
- Viral Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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28
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Ibieta-Zarco BR, Carrillo-García A, Ponce-de-León-Rosales S, Flores-Miranda MM, Mohar A, Lizano M. Frequency and genotype distribution of multiple human papillomavirus infections in cancer of the head and neck in a Mexican population. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 114:350-7. [PMID: 22862976 DOI: 10.1016/j.oooo.2012.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 04/24/2012] [Accepted: 05/06/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the frequency and genotype distribution of single and multiple human papillomavirus (HPV) infections in head and neck squamous cell carcinomas (HNSCCs) in a Mexican population and to assess their associations with smoking and drinking habits and clinicopathologic characteristics. STUDY DESIGN A cross-sectional study was performed on a sample of patients diagnosed with HNSCCs. Tumor DNA was amplified using polymerase chain reaction with HPV consensus and multiplex primers. The associations among HPV status, survival, and clinical characteristics were analyzed. RESULTS Sixteen of the 43 HNSCCs were HPV positive. HPV16 was the most prevalent type, with single infections present in 5 cases, whereas another 5 cases were combined with HPV56 infection. There was a significant association between HPV infection and oropharyngeal cancers. HPV positivity was associated with overall survival at a nearly significant P level of 0.06. CONCLUSIONS Our data support the importance of HPV infection in oropharyngeal cancer, with a trend toward higher survival in HPV-positive cases.
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Affiliation(s)
- Blanca R Ibieta-Zarco
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
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29
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Betiol J, Villa LL, Sichero L. Impact of HPV infection on the development of head and neck cancer. Braz J Med Biol Res 2013; 46:217-26. [PMID: 23532264 PMCID: PMC3854371 DOI: 10.1590/1414-431x20132703] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/03/2013] [Indexed: 01/20/2023] Open
Abstract
Human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC)
is considered to be a distinct clinical entity with better prognosis than the
classical tobacco- and alcohol-associated tumors. The increasing incidence of
this neoplasia during the last decades highlights the need to better understand
the role of HPV in the development of these cancers. Although the proportion of
HNSCC attributed to HPV varies considerably according to anatomical site,
overall approximately 25% of all HNSCC are HPV-DNA positive, and HPV-16 is by
far the most prevalent type. In this review we discuss the existing evidence for
a causal association between HPV infection and HNSCC at diverse anatomical head
and neck subsites.
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Affiliation(s)
- J Betiol
- Laboratório de Biologia Molecular, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo,São Paulo, SP, Brasil
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30
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Jean-Pierre P, Fundakowski C, Perez E, Jean-Pierre SE, Jean-Pierre AR, Melillo AB, Libby R, Sargi Z. Latent structure and reliability analysis of the measure of body apperception: cross-validation for head and neck cancer patients. Support Care Cancer 2013; 21:591-8. [PMID: 22886430 PMCID: PMC4086048 DOI: 10.1007/s00520-012-1561-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/31/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE Cancer and its treatments are associated with psychological distress that can negatively impact self-perception, psychosocial functioning, and quality of life. Patients with head and neck cancers (HNC) are particularly susceptible to psychological distress. This study involved a cross-validation of the Measure of Body Apperception (MBA) for HNC patients. METHODS One hundred and twenty-two English-fluent HNC patients between 20 and 88 years of age completed the MBA on a Likert scale ranging from "1 = disagree" to "4 = agree." We assessed the latent structure and internal consistency reliability of the MBA using Principal Components Analysis (PCA) and Cronbach's coefficient alpha (α), respectively. We determined convergent and divergent validities of the MBA using correlations with the Hospital Anxiety and Depression Scale (HADS), observer disfigurement rating, and patients' clinical and demographic variables. RESULTS The PCA revealed a coherent set of items that explained 38 % of the variance. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.73 and the Bartlett's test of sphericity was statistically significant (χ (2) (28) = 253.64; p < 0.001), confirming the suitability of the data for dimension reduction analysis. The MBA had good internal consistency reliability (α = 0.77) and demonstrated adequate convergent and divergent validities based on statistically significant moderate correlations with the HADS (p < 0.01) and observer rating of disfigurement (p < 0.026) and nonstatistically significant correlations with patients' clinical and demographic variables: tumor location, age at diagnosis, and birth place (all p (s) > 0.05). CONCLUSIONS The MBA is a valid and reliable screening measure of body apperception for HNC patients.
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Affiliation(s)
- Pascal Jean-Pierre
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, Suite 1500 (D-31), Miami, FL 33136-1002, USA.
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31
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Chu A, Genden E, Posner M, Sikora A. A patient-centered approach to counseling patients with head and neck cancer undergoing human papillomavirus testing: a clinician's guide. Oncologist 2013; 18:180-9. [PMID: 23345545 PMCID: PMC3579602 DOI: 10.1634/theoncologist.2012-0200] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/13/2012] [Indexed: 12/21/2022] Open
Abstract
The International Agency for Research on Cancer and the National Cancer Institute have acknowledged human papillomavirus (HPV)-16 as an independent risk factor for oropharyngeal cancer (OPC). HPV-positive oropharyngeal cancer (HPVOPC) is a sexually transmitted entity that is on the rise; within the next 10 years, the annual number of HPV-associated OPC cases is projected to exceed the annual number of cervical cancer cases in the United States. Recognition of HPV status in OPC has broad implications beyond the traditional oncological concerns of timely diagnosis, accurate staging, and appropriate treatment of cancer patients. The National Comprehensive Cancer Network recommends testing the tumor site for HPV-status during OPC management; it is likely this will become a standard component of care for patients with high-probability tumors of the oropharynx. As the practice of HPV testing becomes more common, it behooves providers to be able to adequately address the concerns of patients with HPVOPC. Although there are currently few relevant studies focusing on this population, existing literature on HPV-infected women and patients with cervical cancer strongly supports the concept that patients with HPVOPC need education to optimally address concerns such as self-blame, guilt, intimacy, and interpersonal relationships. When HPV testing is done, it should be accompanied by evidence-driven and patient-centered counseling to best minimize negative psychosocial outcomes and ensure optimum health promotion. Based on the current state of the literature, this article is intended to be a reference for physicians to effectively manage psychosocial outcomes when diagnosing patients with HPV-associated OPC.
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Affiliation(s)
- Amy Chu
- Departments of Otolaryngology
| | | | | | - Andrew Sikora
- Departments of Otolaryngology
- Dermatology
- Oncological Sciences, and
- Immunology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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32
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Schobert D, Remy V, Schoeffski O. Cost-effectiveness of vaccination with a quadrivalent HPV vaccine in Germany using a dynamic transmission model. HEALTH ECONOMICS REVIEW 2012; 2:19. [PMID: 23009387 PMCID: PMC3575401 DOI: 10.1186/2191-1991-2-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 09/05/2012] [Indexed: 05/24/2023]
Abstract
UNLABELLED INTRODUCTION Persistent infections with human papillomavirus (HPV) are a necessary cause of cervical cancer and are responsible for important morbidity in men and women. Since 2007, HPV vaccination has been recommended and funded for all girls aged 12 to 17 in Germany. A previously published cost-effectiveness analysis, using a static model, showed that a quadrivalent HPV vaccination programme for 12-year-old girls in Germany would be cost effective. Here we present the results from a dynamic transmission model that can be used to evaluate the impact and cost-effectiveness of different vaccination schemas. METHODS We adapted a HPV dynamic transmission model, which has been used in other countries, to the German context. The model was used to compare a cervical cancer screening only strategy with a strategy of combining vaccination of females aged 12-17 years old and cervical cancer screening, based on the current recommendations in Germany. In addition, the impact of increasing vaccination coverage in this cohort of females aged 12-17 years old was evaluated in sensitivity analysis. RESULTS The results from this analysis show that the current quadrivalent HPV vaccination programme of females ages 12 to 17 in Germany is cost-effective with an ICER of 5,525€/QALY (quality adjusted life year). The incremental cost-effectiveness ratio (ICER) increased to 10,293€/QALY when the vaccine effects on HPV6/11 diseases were excluded. At steady state, the model predicted that vaccinating girls aged 12 to 17 could reduce the number of HPV 6/11/16/18-related cervical cancers by 65% and genital warts among women and men by 70% and 48%, respectively. The impact on HPV-related disease incidence and costs avoided would occur relatively soon after initiating the vaccine programme, with much of the early impact being due to the prevention of HPV6/11-related genital warts. CONCLUSIONS These results show that the current quadrivalent HPV vaccination and cervical cancer screening programmes in Germany will substantially reduce the incidence of cervical cancer, cervical intraepithelial neoplasia (CIN) and genital warts. The evaluated vaccination strategies were all found to be cost-effective. Future analyses should include more HPV-related diseases.
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Affiliation(s)
- Deniz Schobert
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-University Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Germany
| | - Vanessa Remy
- Market Access, Vaccine Advocacy & Medical Affairs, Sanofi Pasteur MSD, 8 rue Jonas Salk, 69007, Lyon, France
| | - Oliver Schoeffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-University Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Germany
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Joh J, Jenson AB, Proctor M, Ingle A, Silva KA, Potter CS, Sundberg JP, Ghim SJ. Molecular diagnosis of a laboratory mouse papillomavirus (MusPV). Exp Mol Pathol 2012; 93:416-21. [PMID: 22796029 DOI: 10.1016/j.yexmp.2012.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/03/2012] [Indexed: 11/29/2022]
Abstract
MusPV, a novel papillomavirus (PV) that naturally infects laboratory mice, was isolated and characterized from a colony of NMRI-Foxn1(nu)/Foxn1(nu) (nude) mice in India. Because MusPV may have been missed during routine pathogen screening of mice in colonies worldwide, a variety of detection methods are described to detect MusPV. The clinical and histologic lesions of productive MusPV infections fit PV-associated features, including papillomas, koilocytes within the stratum granulosum of the hyperplastic/acanthotic papillomatous epithelium, and the presence of intranuclear virus particles in koilocytotic cells visualized by electron microscopy. Antiserum against disrupted PV virions, isolated from another species (canine), identified conserved viral antigens in productively infected cells by immunohistochemistry. A rolling circle technique was used to amplify viral circular DNAs followed by endonuclease restriction enzyme digestion to determine the correct size of PV DNA. Consensus PV degenerative primers, My09/11, commonly used to detect many different types of PVs by polymerase chain reaction (PCR), particularly mucosotropic HPVs, also identified MusPV and all rodent PVs tested. Since there was one nucleotide mismatch between the My09/11 primer set and the MusPV template, a new primer set, MusPV-My09/11, was designed to specifically detect MusPV in latent infections and spontaneous MusPV-induced papillomas. Southern blot analysis verified the presence of full size PV DNA in infected tissues. Virus-like particles (VLPs), generated from MusPV L1 genes, provided a substrate for serological testing of naturally and experimentally infected mice. In summary, a series of diagnostic assays were developed and validated to detect MusPV infection in skin tumors and serological response in laboratory mice.
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Affiliation(s)
- Joongho Joh
- Department of Medicine, James Graham Brown Cancer Center (JGBCC), USA
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34
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Is human papillomavirus involved in laryngeal neuroendocrine carcinoma? Eur Arch Otorhinolaryngol 2012; 270:719-25. [PMID: 22699626 PMCID: PMC3560955 DOI: 10.1007/s00405-012-2075-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/31/2012] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to detect human papillomavirus (HPV) infection in laryngeal neuroendocrine carcinoma (LNEC) and to explore the possible relationship between HPV-induced malignant transformation and prognosis in LNEC. Ten cases of LNEC from a tertiary referral hospital were retrospectively analyzed. Clinical data were subtracted from patients’ files. Pretreatment biopsy material was tested for the presence of HPV6, 11, 16, and 18 using a PCR-based detection method. Immunohistochemical staining was performed for Ki-67, p16INK4A, and p53 expression. All cases were negative for the low-risk HPV types HPV6 and HPV11 that are associated with laryngeal papillomatosis. High-risk HPV was detected in two cases; an atypical carcinoid was positive for HPV16 and a large-cell neuroendocrine carcinoma for HPV18. Both HPV-positive tumors had a high Ki-67 labeling index. Two of the four cases with a good response to therapy were hrHPV-positive (both HPV DNA positive) compared with none of the five poor responders. Our findings show that HPV may play a role in the pathogenesis of LNEC. The relationship between HPV, improved prognosis and good response to therapy for squamous cell carcinoma of the head and neck may also be true for a subset of LNEC.
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35
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Fera D, Schultz DC, Hodawadekar S, Reichman M, Donover PS, Melvin J, Troutman S, Kissil J, Huryn DM, Marmorstein R. Identification and characterization of small molecule antagonists of pRb inactivation by viral oncoproteins. CHEMISTRY & BIOLOGY 2012; 19:518-28. [PMID: 22520758 PMCID: PMC3334872 DOI: 10.1016/j.chembiol.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 01/21/2012] [Accepted: 03/01/2012] [Indexed: 11/23/2022]
Abstract
The retinoblastoma protein pRb is essential for regulating many cellular activities through its binding and inhibition of E2F transcription activators, and pRb inactivation leads to many cancers. pRb activity can be perturbed by viral oncoproteins including human papillomavirus (HPV) that share an LxCxE motif. Because there are no treatments for existing HPV infection leading to nearly all cervical cancers and other cancers to a lesser extent, we screened for compounds that inhibit the ability of HPV-E7 to disrupt pRb/E2F complexes. This lead to the identification of thiadiazolidinedione compounds that bind to pRb with mid-high nanomolar dissociation constants, are competitive with the binding of viral oncoproteins containing an LxCxE motif, and are selectively cytotoxic in HPV-positive cells alone and in mice. These inhibitors provide a promising scaffold for the development of therapies to treat HPV-mediated pathologies.
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Affiliation(s)
- Daniela Fera
- Program in Gene Expression and Regulation, The Wistar Institute, Philadelphia, PA 19104, USA
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David C. Schultz
- Program in Gene Expression and Regulation, The Wistar Institute, Philadelphia, PA 19104, USA
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Santosh Hodawadekar
- Program in Gene Expression and Regulation, The Wistar Institute, Philadelphia, PA 19104, USA
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Melvin Reichman
- The Lankenau Institute for Medical Research, Chemical Genomics Center, Wynnewood, PA 19096, USA
| | - Preston Scott Donover
- The Lankenau Institute for Medical Research, Chemical Genomics Center, Wynnewood, PA 19096, USA
| | - Jason Melvin
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Scott Troutman
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Joseph Kissil
- Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, PA 19104, USA
| | - Donna M. Huryn
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ronen Marmorstein
- Program in Gene Expression and Regulation, The Wistar Institute, Philadelphia, PA 19104, USA
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
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De Costa AMA, Schuyler CA, Walker DD, Young MRI. Characterization of the evolution of immune phenotype during the development and progression of squamous cell carcinoma of the head and neck. Cancer Immunol Immunother 2011; 61:927-39. [PMID: 22116344 DOI: 10.1007/s00262-011-1154-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/02/2011] [Indexed: 12/12/2022]
Abstract
While studies have indicated that squamous cell carcinoma of the head and neck (HNSCC) is associated with immune suppression, these studies did not analyze the immune response at the dysplastic stage. The present study utilized a mouse model of 4-nitroquinoline 1-oxide-induced oral carcinogenesis to examine the alterations in immune phenotype at the premalignant and malignant stages of HNSCC. Cervical lymph nodes of HNSCC-bearing mice were found to contain a greater number of cells, including a greater number of conventional (Tconv) and regulatory (Treg) T cells, compared to cervical lymph nodes of control and premalignant lesion-bearing mice, though the Tconv cells appear to be less proliferative and the Treg cells appear to be less suppressive at the HNSCC stage. Premalignant lesion-bearing mouse lymph nodes consist of a greater percentage of Tconv cells expressing markers for activation, memory, and exhaustion compared to both control and HNSCC-bearing mice. Also, lymph nodes' cells from both premalignant lesion-bearing and HNSCC-bearing mice include increased levels of Th1, Tc1, and Th17 cells, with no differences in levels of Th2 cells, compared to control mice. The data show that while there is the expected increase in immunosuppressive Tregs in lymph nodes when HNSCC is present, there is also an unexpected increase in immune populations usually associated with a beneficial antitumor response, including Tconv cells and Th1 and Tc1 cells. In addition, the results demonstrate that the premalignant stage of HNSCC development is associated with a robust immune response involving an increase in inflammatory Th1, Tc1, and Th17 cells.
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Affiliation(s)
- Anna-Maria A De Costa
- Research Service (151), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA
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Vaidyanathan K, Vasudevan DM. Organ Specific Tumor Markers: What's New? Indian J Clin Biochem 2011; 27:110-20. [PMID: 23542399 DOI: 10.1007/s12291-011-0173-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/11/2011] [Indexed: 12/29/2022]
Abstract
Tumor markers are molecules produced in the body in response to cancer. An ideal tumor marker should have high sensitivity and specificity, should be cheap, and should be easily detected in body fluids. Identification of novel markers is important and it is expected that with the advent of newer technologies, more reliable markers will be discovered. This review discusses the currently available tumor markers for different malignancies.
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Affiliation(s)
- Kannan Vaidyanathan
- Department of Biochemistry, Amrita Institute of Medical Science, Kochi, 682041 Kerala India
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