scholarly journals Human Papillomavirus Associated Oropharyngeal Carcinoma-Diagnosis and Management

2021 ◽  
Author(s):  
Mullangath Prakasan Aparna ◽  
Ravi Rejnish Kumar ◽  
Malu Rafi ◽  
Geethu Babu ◽  
Pradeep Naveen Kumar ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Head And Neck ◽  
Locally Advanced ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Oropharyngeal Carcinoma ◽  
Upper Aerodigestive Tract ◽  
Separate Clinical Entity ◽  
Advanced Stages ◽  
Management Of Hpv

Head and neck squamous cell carcinomas arise from the mucosa of the upper aerodigestive tract and is often driven by risk factors like tobacco and alcohol consumption. Most of the time patients present with locally advanced stages and the outcome is poor, despite recent advances in multi-modality treatment. The epidemiology of the disease has changed over the last decade with the introduction of a separate clinical entity; Human Papillomavirus (HPV) associated head and neck cancer. The tumorigenesis is different from that of tobacco and alcohol-driven malignancies. These tumors have a better response to treatment owing to their inherent genetic makeup and carry an excellent prognosis. The current school of thought is to reduce the long-term morbidities associated with various treatment modalities, as these patients tend to survive longer. The best management of HPV-associated oropharyngeal cancer is under active investigation.

scholarly journals Postoperative Radiochemotherapy Using Modern Radiotherapy Techniques in Elderly Patients with Head and Neck Squamous Cell Carcinoma: The Challenge of Weighing up Benefits and Harms of Treatment Modalities in Clinical Practice

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3384
Author(s):  
Martin Leu ◽  
Christoph Patzer ◽  
Manuel Guhlich ◽  
Jacqueline Possiel ◽  
Yiannis Pilavakis ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Head And Neck ◽  
Squamous Cell ◽  
Systemic Treatment ◽  
Locally Advanced ◽  
Treatment Modalities ◽  
Younger Patients ◽  
Radiotherapy Techniques ◽  
Postoperative Radiochemotherapy ◽  
Modern Radiotherapy

Locally advanced head and neck squamous cell carcinomas (HNSCC) are often managed with surgery followed by postoperative radiochemotherapy (RCT). With the general increase in life expectancy, the proportion of elderly patients with HNSCC is expected to grow rapidly. Until now, a deeper understanding of specific management strategies for these patients in clinical routine was lacking. In the present study, we compared elderly patients (≥70 years, n = 52) and younger patients (n = 245) treated with postoperative RCT for HNSCC at our tertiary cancer center. All patients were irradiated with modern radiotherapy techniques (IMRT/VMAT). Patients ≥70 years of age had more comorbidities. Additionally, elderly patients less frequently received concomitant systemic treatment. The rates of mucositis and dermatitis were lower in patients ≥70 years. Elderly patients had significantly worse overall and progression-free survival. Locoregional and distant control were comparable in elderly and younger patients. In conclusion, postoperative RCT is a safe and effective treatment option in patients ≥70 years. In light of comorbidities and poor overall survival rates, benefits and harms of radiotherapy and concomitant systemic treatment should be weighed carefully. When exclusively applying up-to-date radiotherapy techniques with, at the same time, careful use of concomitant systemic therapy, favorable acute toxicity profiles are achieved.

scholarly journals Neoadjuvant and Adjuvant Pembrolizumab in Resectable Locally Advanced, Human Papillomavirus-Unrelated Head and Neck Cancer: A Multicenter, Phase 2 Trial

2020 ◽  
Author(s):  
Ravindra Uppaluri ◽  
Katie M. Campbell ◽  
Ann Marie Egloff ◽  
Paul Zolkind ◽  
Zachary L. Skidmore ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Head And Neck ◽  
Relapse Rate ◽  
Locally Advanced ◽  
Giant Cells ◽  
Phase 2 ◽  
Phase 2 Trial ◽  
One Year ◽  
The One

SUMMARYBackgroundPembrolizumab improved survival of patients with recurrent or metastatic head and neck squamous-cell carcinoma (HNSCC). The aims of this phase 2 trial were to determine if pembrolizumab administered to patients with resectable locally advanced, human papillomavirus (HPV)-unrelated HNSCC would be safe, result in pathologic tumor response (pTR), and lower the relapse rate.MethodsNeoadjuvant pembrolizumab (200 mg) was administered 2-3 weeks before surgery. Resection of the primary tumor and involved/at-risk nodes was performed. Post-operative (chemo) radiation was planned. Patients with high-risk pathology (positive margins and/or extranodal extension) were to receive adjuvant pembrolizumab. pTR was quantified as the proportion of the resection bed with tumor necrosis, keratinous debris, and giant cells/histiocytes: pTR-0 (<10%), pTR-1 (10-49%), and pTR-2 (≥50%). Co-primary endpoints were pTR-2 among all patients, and one-year relapse rate in patients with high-risk pathology (historical: 35%). Correlations of baseline PD-L1 expression and T-cell infiltration with pTR were assessed, and tumor clonal dynamics were evaluated. Analyses were done per protocol. This trial is registered with ClinicalTrials.gov(NCT02296684), and is ongoing but closed to accrual.FindingsBetween June 30, 2015, and March 30, 2018, 36 patients enrolled. After neoadjuvant pembrolizumab, serious (grades 3-4) adverse events and unexpected surgical delays/complications did not occur. pTR-2 occurred in eight patients (22%), and pTR-1 in eight other patients (22%). pTR ≥10% correlated with baseline tumor PD-L1 expression, immune infiltrate, and IFN-γ pathway activity. Matched sample analysis showed compensatory upregulation of multiple immune inhibitory checkpoints in patients with pTR-0, and confirmed that clonal loss occurred in some patients. The one-year relapse rate among the eighteen patients with high-risk pathology was 16.7% (95%CI: 3.6-41.4%).ConclusionsAmong patients with locally advanced, HPV-unrelated HNSCC, neoadjuvant pembrolizumab was safe, and resulted in pTR-1 or pTR-2 in 44% of patients. The one-year relapse rate in patients with high-risk-pathology was lower than historical.FundingMerck, NCI, NIDCR, NHGRI and The V Foundation.

Association of Cystic Neck Metastases and Human Papillomavirus–Positive Oropharyngeal Squamous Cell Carcinoma

2009 ◽  
Vol 133 (11) ◽  
pp. 1798-1803
Author(s):  
Jonathan B. McHugh
Keyword(s):  
Squamous Cell Carcinoma ◽  
Human Papillomavirus ◽  
High Risk ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Sexual Behaviors ◽  
Oropharyngeal Squamous Cell Carcinoma ◽  
Treatment Modalities ◽  
Neck Metastases

Abstract Human papillomavirus is an established cause of oropharyngeal squamous cell carcinoma. Similar to cervical cancer, these cancers are usually caused by high-risk human papillomavirus types 16 and 18 and are associated with high-risk sexual behaviors. Human papillomavirus–associated oropharyngeal squamous cell carcinoma typically affects the palatine and lingual tonsils and frequently results in cystic neck metastases. The histopathology of this subset of head and neck squamous cell carcinoma is unique and typically characterized by poorly differentiated, nonkeratinizing morphology with a basaloid appearance. These tumors occur in younger patients and are more often seen in nonsmokers compared with conventional oral cavity and oropharyngeal squamous cell carcinomas. The incidence of human papillomavirus–associated squamous cell carcinoma is increasing. Recognition of this unique clinicopathologic subset of head and neck carcinoma is important because these patients typically respond more favorably to organ-sparing treatment modalities and have an improved prognosis.

scholarly journals Management of HPV-Related Squamous Cell Carcinoma of the Head and Neck: Pitfalls and Caveat

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 975 ◽  
Author(s):  
Francesco Perri ◽  
Francesco Longo ◽  
Francesco Caponigro ◽  
Fabio Sandomenico ◽  
Agostino Guida ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Therapeutic Strategies ◽  
Squamous Cell Carcinomas ◽  
The Other ◽  
Upper Aerodigestive Tract ◽  
Clinical Behavior ◽  
Different Types ◽  
Management Of Hpv

Head and neck squamous cell carcinomas (HNSCCs) are a very heterogeneous group of malignancies arising from the upper aerodigestive tract. They show different clinical behaviors depending on their origin site and genetics. Several data support the existence of at least two genetically different types of HNSCC, one virus-related and the other alcohol and/or tobacco and oral trauma-related, which show both clinical and biological opposite features. In fact, human papillomavirus (HPV)-related HNSCCs, which are mainly located in the oropharynx, are characterized by better prognosis and response to therapies when compared to HPV-negative HNSCCs. Interestingly, virus-related HNSCC has shown a better response to conservative (nonsurgical) treatments and immunotherapy, opening questions about the possibility to perform a pretherapy assessment which could totally guide the treatment strategy. In this review, we summarize molecular differences and similarities between HPV-positive and HPV-negative HNSCC, highlighting their impact on clinical behavior and on therapeutic strategies.

scholarly journals Human papillomavirus in head and neck cancer in India: Current status and consensus recommendations

2017 ◽  
Vol 06 (03) ◽  
pp. 093-098 ◽  
Author(s):  
Vedang Murthy ◽  
Adnan Calcuttawala ◽  
Kirti Chadha ◽  
Anil d’Cruz ◽  
Arvind Krishnamurthy ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Head And Neck ◽  
Current Status ◽  
The West ◽  
Current Role ◽  
High Risk Sexual Behavior ◽  
Medical Oncologists ◽  
Management Of Hpv ◽  
Risk Sexual Behavior ◽  
Indian Scenario

AbstractHuman papillomavirus (HPV) associated head and neck squamous cell cancers (HNSCC) have become increasingly common in the West, but the same cannot be said about India. These cancers have a different biology and confer a better prognosis, however, its current role in the management of patients in India is not clearly defined. At the 35th Indian Cooperative Oncology Network conference held in September 2016, a panel of radiation, surgical and medical oncologists, pathologists, and basic scientists from across the country having experience in clinical research with respect to HPV in HNSCC reviewed the available literature from India. All the ideas and facts were thereafter collated in this report. Various topics of controversy in dealing with the diagnosis and management of HPV-associated HNSCC have been highlighted in this report in context to the Indian scenario. Furthermore, the prevalence of the same and its association with tobacco and high-risk sexual behavior has been touched on. Conclusively, a set of recommendations has been proposed by the panel to guide the practicing oncologists of the country while dealing with HPV-associated HNSCC.

Small Cell Carcinoma in the Head and Neck

2019 ◽  
Vol 128 (11) ◽  
pp. 1006-1012 ◽  
Author(s):  
Takahiro Wakasaki ◽  
Ryuji Yasumatsu ◽  
Muneyuki Masuda ◽  
Mioko Matsuo ◽  
Akihiro Tamae ◽  
...  
Keyword(s):  
Head And Neck ◽  
Distant Metastasis ◽  
Radical Surgery ◽  
Survival Rates ◽  
Observation Time ◽  
Small Cell ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Disease Entities ◽  
Stage Ivb

Objectives: Small cell carcinomas in extrapulmonary sites (ESmCCs) are very rare. ESmCCs originating in the head and neck account for approximately 10% of all ESmCCs, and there are few reports about this disease. ESmCCs have an aggressive natural history characterized by widespread metastasis. The aim of this study was to investigate the characteristics and outcomes of patients with ESmCCs of the head and neck. Methods: The outcomes of 21 patients with ESmCCs of the head and neck treated between January 2001 and December 2015 at the authors’ hospital and associated facilities were reviewed. Results: There were 18 men and 3 women, and the median age was 74 years (range, 53-91 years). The tumor site was the larynx in 6 patients; the paranasal sinus in 5; the hypopharynx in 3; the oropharynx in 2; the nasopharynx in 2; and the oral cavity, salivary gland, and primary unknown in 1 patient each. The extent of the disease was staged as follows: stage I or II, 3 cases; stage III, 4 cases; stage IVA, 9 cases; stage IVB, 1 case; and stage IVC, 4 cases. The median observation time was 17 months (range, 1-103 months). Four patients (19%) had distant metastasis at initial treatment, and 13 patients (62%) developed distant metastasis within 3 years. Treatments were administered, including radical surgery (9 patients), radiation therapy (5 patients), chemoradiotherapy (7 patients), and chemotherapy (6 patients). The 1- and 3-year overall survival rates of patients were 56% and 37%, respectively. More than half of the patients died of distant metastasis. Conclusions: ESmCCs of the head and neck have a poor prognosis, similar to those of carcinomas in many other sites. Control of distant metastasis would contribute to improving the prognosis of ESmCCs of the head and neck. Further studies are required for better understanding these disease entities and their response to treatment modalities.

Proton re-irradiation of Sinonasal Esthesioneuroblastoma: a Case Report

2021 ◽  
Vol 1 (1) ◽  
pp. 75-81
Author(s):  
Konstantin Gordon ◽  
Igor Gulidov ◽  
Danil Gogolin ◽  
Olga Lepilina ◽  
Olga Golovanova ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Head And Neck ◽  
Local Control ◽  
Proton Therapy ◽  
Locally Advanced ◽  
Comprehensive Treatment ◽  
Sinonasal Tumor ◽  
Advanced Stages ◽  
Novel Approaches

"Head and neck (H&N) cancers are in the 7-8th place among all types of cancer. Despite novel approaches in cancer treatment, most of the patients have a high risk of loco-regional recurrence. Esthesioneuroblastoma (ENB) is a very rare H&N neoplasm, accounting for only 3-6% of all intranasal tumors. These tumors usually are presented with locally advanced stages and required radiotherapy as a part of the comprehensive treatment. Loco-regional failures represent a challenge, and re-irradiation can be effective for some groups of patients. We present a case of re-irradiation with protons of sinonasal tumor in a 49-years old patient with recurrent ENB, involving visual structures. We achieved a 5-year positive local control after the proton therapy (PT), without significant toxicity.The case shows an example of re-irradiation as an essential area for PT application,given the need to maximize the treatment's efficacy and minimize the risk of severetoxicity."

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