Human papillomavirus and oropharyngeal squamous cell carcinoma: a 12-year retrospective review in a New South Wales tertiary referral centre

Taylor, Alon; Eade, Thomas; Veivers, David; Gill, Anthony J.; Pang, Leo

doi:10.21037/ajo.2019.01.01

Cited by 5 publications

(5 citation statements)

References 34 publications

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“… 5 , 6 Despite the presence of lymphadenopathy, the prognosis of HPV-related OPSCC is favorable given that this cancer is treatment sensitive. 7 , 8 HPV-positive OPSCC patients have higher rates of overall survival (82.4% vs 57.1%) and 3 year progression-free survival (73.7% vs 43.4%) than HPV-negative OPSCC patients. 9 Given the minimal symptom burden at diagnosis as well as the high rates of overall long-term survival, preservation of high quality of life (QOL) is a therapeutic goal.…”

Section: Introductionmentioning

confidence: 96%

A Descriptive Study of Quality of Life Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma

Diaconescu,

Silver,

Subramaniam

et al. 2024

Journal of Otolaryngology - Head & Neck Surgery

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Background Patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with radiation-based therapy suffer from short- and long-term toxicities that affect quality of life (QOL). Transoral robotic surgery (TORS) has an established role in the management of early OPSCC but adjuvant treatment is often indicated postoperatively due to the high incidence of nodal metastasis associated with advanced human papillomavirus (HPV)-related OPSCC. To overcome the need for adjuvant radiation therapy (RT), neoadjuvant chemotherapy followed by TORS and neck dissection (ND) is proposed. This study aimed to assess if QOL in HPV-associated OPSCC receiving neoadjuvant chemotherapy followed by TORS and ND returns to baseline within 12 months of completing treatment. Methods A 12 month longitudinal study was carried out at McGill University Health Centre in Montreal, Canada, among a convenience sample of patients with American Joint Committee on Cancer Seventh Edition stage III and IVa HPV-related OPSCC who were treated with neoadjuvant chemotherapy followed by TORS and ND. QOL data were obtained pretreatment and at 1, 3, 6, and 12 months following treatment completion using the European Organisation for Research and Treatment of Cancer Core and Head and Neck extension modules. Paired t tests and mixed models for repeated measures analysis were used to assess changes in QOL from baseline to 12 months postoperatively and over time, respectively. Results Nineteen of 23 patients (median age 58 years) who received the study treatment fulfilled the eligibility criteria. OPSCC subsites were palatine tonsil (n = 12) and base of tongue (n = 7). All 19 patients were treated per protocol and none required adjuvant RT as per pathology review and protocol requirements at a postoperative multidisciplinary team tumor board discussion. No significant differences were found when comparing 12 month QOL follow-up scores to pretreatment scores in measures that would likely be affected by RT [eg, swallowing ( P = .7), social eating ( P = .8), xerostomia ( P = .9)]. Conclusion In HPV-related OPSCC, neoadjuvant chemotherapy followed by TORS and ND as definitive treatment is associated with excellent QOL outcomes. Postoperative QOL scores returned to baseline by 3 months and were maintained for all measures, indicating a return to normal function.

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Section: Introductionmentioning

confidence: 96%

A Descriptive Study of Quality of Life Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma

Diaconescu,

Silver,

Subramaniam

et al. 2024

Journal of Otolaryngology - Head & Neck Surgery

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“…There is an increasing incidence of human papillomavirus−associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) . Patients with this form of OPSCC have a better prognosis than those with conventional OPSCC treated with standard therapies . Clinical presentation differs between these 2 groups given that patients with HPV-OPSCC tend to be younger and healthier, and most (60%-70%) have positive nodal disease at the time of diagnosis …”

Section: Introductionmentioning

confidence: 99%

“…1,2 Patients with this form of OPSCC have a better prognosis than those with conventional OPSCC treated with standard therapies. [3][4][5] Clinical presentation differs between these 2 groups given that patients with HPV-OPSCC tend to be younger and healthier, and most (60%-70%) have positive nodal disease at the time of diagnosis. 2,[6][7][8][9] Standard management algorithms for newly diagnosed HPV-OPSCC cases opt for definitive concurrent chemoradiotherapy (CRT) or surgical resection with adjuvant radiation (RT) or CRT depending on pathologic risk stratification; therefore, 90% or more of these patients are treated with RT.…”

mentioning

confidence: 99%

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

Silver,

Bouganim,

Richardson

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceEfforts are underway to deintensified treatment protocols for patients with human papillomavirus virus−associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes.ObjectiveTo assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS.Design, Settings, and ParticipantsThis was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses.Outcome MeasuresQOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes.ResultsAmong the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, −4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, −1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret.Conclusion and RelevanceThe findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.

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“…The increased incidence, which is particularly notable among males and younger cohorts, may be attributable to increased carriage of high-risk HPV types (especially HPV 16 or 18) via increased oral exposure to infected anogenital sites with changing sexual behaviors, as opposed to the more traditional risk factors such as smoking and alcohol [ 7 , 8 ]. Although estimates vary by setting, the proportion of OPSCC attributable to HPV (mainly HPV 16) has been cited in high-income countries as between 65% and 83% [ 9 - 11 ]. OPSCC has now surpassed cervical cancer as the most common HPV-driven cancer [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Indigenous Australian Human Papillomavirus (HPV) Cohort Study 2, Continuation for 5 to 10 Years: Protocol for a Longitudinal Study

Hedges¹,

Sethi²,

Garvey³

et al. 2023

JMIR Res Protoc

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Background Human papillomavirus (HPV) infection, a common sexually transmitted disease, is associated with cancers of the cervix, vulva, vagina, penis, anus, and head and neck. Oropharyngeal squamous cell carcinoma (OPSCC; throat cancer) is a type of cancer involving the head and neck area that is rapidly increasing across the globe. There are higher rates of OPSCC among Indigenous populations relative to non–Indigenous Australian populations, although the HPV-attributable fraction remains unknown. For the first time at a global level, we plan to extend an Indigenous Australian adult cohort to monitor, screen, and ultimately prevent HPV-associated OPSCC and to undertake extensive cost-effectiveness modelling around HPV vaccination. Objective This study aims to (1) extend follow-up to a minimum of 7 years post recruitment to describe the prevalence, incidence, clearance, and persistence of oral HPV infection; and (2) conduct clinical examinations of the head and neck, oral cavity, and oropharynx and collect saliva samples for early-stage OPSCC testing. Methods We will continue to implement a longitudinal design for the next study phase, where we will ascertain the prevalence, incidence, clearance, and persistence of oral HPV infection at 48, 60, and 72 months; undertake clinical examinations/saliva assessments to detect early-stage OPSCC; and refer for treatment. The primary outcome measures are changes in oral HPV infection status, biomarker measures of early HPV-related cancer, and clinical evidence of early-stage OPSCC. Results Participant 48-month follow-up will commence in January 2023. The first results are expected to be submitted for publication 1 year after 48-month follow-up begins. Conclusions Our findings have potential to change the way in which OPSCC among Australian Indigenous adults is managed, with desired impacts including cost-savings on expensive cancer treatments; improved nutritional, social, and emotional outcomes; and improved quality of life for both Indigenous adults and the Indigenous community more broadly. Continuing a large, representative Indigenous adult cohort to track oral HPV infection and monitor early OPSCC is essential to yield critical information to include in the management armamentarium of health and well-being recommendations for Australia’s First Nations. International Registered Report Identifier (IRRID) PRR1-10.2196/44593

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Human papillomavirus and oropharyngeal squamous cell carcinoma: a 12-year retrospective review in a New South Wales tertiary referral centre

Cited by 5 publications

References 34 publications

A Descriptive Study of Quality of Life Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma

A Descriptive Study of Quality of Life Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

The Indigenous Australian Human Papillomavirus (HPV) Cohort Study 2, Continuation for 5 to 10 Years: Protocol for a Longitudinal Study

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