Human Papillomavirus-Associated Head and Neck Cancers. Where are We Now? A Systematic Review

Abstract

Background Human papillomavirus targets the skin and mucous membranes, producing benign hyperplastic lesions and precancerous and cancerous lesions. An increasing number of head and neck cancersin particular, oropharyngeal squamous cell carcinoma, laryngeal squamous cell carcinoma, and oral squamous cell carcinoma, are attributable to HPV infection. HPV-induced HNCs typically affect younger, nonsmoking patients with no prior history of heavy alcohol use, more extensive sexual history, and higher socioeconomic status. Aim The purpose of the review is to present the most recent and well-established findings concerning HPV-induced head and neck cancers and consequently to provide medical specialists with essential information regarding the epidemiology, the role of HPV in HNC cancerogenesis, prevention, diagnosis, and treatment. Material and Methods All authors independently have searched The EMbase, Medline/Pubmed, and Cochrane databases by using the following keywords “head and neck cancer”, “human papillomavirus”, “HPV”, “HPV biology”, “oropharyngeal squamous cell carcinoma”, “carcinogenesis”, “transoral surgery”, “robotic surgery”. The last search was conducted in March 2022. The references of the publications of interest were also screened for relevant papers. There were no limitations in regard to the publication date. Conclusion Aiming to avoid the epidemic of HPV-induced HNC, it is paramount to improve the access to vaccination as well as resolve parental concerns regarding vaccine safety. Physicians should rely on reduced-dose radiation and aim to reduce the overall treatment time. Thanks to a more elaborate understanding of the genomic background of HPV-induced HNC, precision medicine could become a relevant part of patients’ management. In comparison to traditional techniques and non-operative treatment, transoral robotic surgery (TORS) offers similar oncologic and functional outcomes, with a possible benefit on long-term quality of life. However, more research is needed to establish clear guidelines indicating when TORS resections should be supported with adjuvant therapy.

Esophageal and Head and Neck Cancer Patients Attending Ocean Road Cancer Institute in Tanzania from 2019 to 2021: An Observational Study

“…Oropharyngeal cancer was diagnosed among 8.8% of the cancer patients in this study. Human papilloma virus (HPV) is known to be associated with this cancer type [ 56 ]. Unfortunately, we had no information about the HPV status of the patients in this study.…”

A systematic literature review of the human papillomavirus prevalence in locally and regionally advanced and recurrent/metastatic head and neck cancers through the last decade: The “ALARM” study

“…[28][29][30] The proportion of those patients who are HPV-positive (HPV+) remains unknown, as available data are not only outdated, but also mainly refer to the totality of HNCs, not distinguishing the disease by stage. 5,[31][32][33][34][35][36][37] This information is particularly relevant considering that available HPV prophylactic vaccines have shown preliminary efficacy against HN infections, opening an opportunity for primary prevention of the specific cancers, [38][39][40][41][42] with this potential being investigated in ongoing Phase III clinical trials. 43,44 Given the challenges in the management of LA and RM HNC, and the increasing incidence of HPV-associated HNC, updated information on the HPV prevalence is essential, with possible implications for preventive interventions.…”

“…Importantly, more than 50% of HNSCC patients present with locally and regionally advanced (LA) or metastatic HNSCC at diagnosis, while recurrence rates for LA HNSCC are high 28–30 . The proportion of those patients who are HPV‐positive (HPV+) remains unknown, as available data are not only outdated, but also mainly refer to the totality of HNCs, not distinguishing the disease by stage 5,31–37 . This information is particularly relevant considering that available HPV prophylactic vaccines have shown preliminary efficacy against HN infections, opening an opportunity for primary prevention of the specific cancers, 38–42 with this potential being investigated in ongoing Phase III clinical trials 43,44 …”

Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization

“…Most HPV infections regress spontaneously without sequalae [ 5 ], but in a small percentage of patients, persistent HR-HPV infections could lead to the development of precancerous (intraepithelial neoplasia) and/or invasive cancerous lesions not only in the cervix but also in other body districts (including the whole lower genital tract, the anus and the head-neck district) [ 6 , 7 , 8 , 9 ]. The uterine cervix remains the most anatomically frequent site involved in HPV-related pre-invasive or invasive lesions [ 10 , 11 ].…”