Optimization of therapeutic strategy for p16‐positive oropharyngeal squamous cell carcinoma: Multi‐institutional observational study based on the national Head and Neck Cancer Registry of Japan

Abstract

Background Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de‐escalating treatment modality has not been established to date. Methods The authors conducted a retrospective, nationwide, observational study in patients with HPV‐related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. Results A total of 688 patients who were newly diagnosed with HPV‐related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow‐up data available were included in the current study. In patients with T1‐T2N0 disease (79 patients), both the 3‐year recurrence‐free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3‐year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV‐related OPSCC, the 5‐year recurrence‐free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high‐dose cisplatin (≥160 mg/m2; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low‐dose cisplatin (<160 mg/m2; 17 patients). Conclusions Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1‐T2N0 HPV‐related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV‐related OPSCC other than those with T1‐T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2.

Prognostic Influence of Tobacco Smoking on Human Papilloma Virus-Related Oropharyngeal Cancer is Dependent Upon Treatment Modality

“…TNM-8 uses p16 positivity as a surrogate of HPV infection similar to this study. Although some have reported better differentiation of OS according to stages by TNM-8 than by 7th edition TNM classi cation (7)(8)(9), there are also reports indicating that prognoses according to the stages are inadequately differentiated, especially between stage II and III by using TNM-8 for p16positive OPSCC (10)(11)(12). Current study showed the stages de ned by TNM-8 were inadequate in differentiating OS and DSS.…”

Current Updates on Cancer-Causing Types of Human Papillomaviruses (HPVs) in East, Southeast, and South Asia

“…Rather, transoral surgery or radiotherapy could be sufficient to curb disease progression and offer an elevated quality of life. In advanced stages of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), induction chemotherapy and chemoradiotherapy with cisplatin tends to be the choice of treatment [ 218 ]. A Japanese team showed that the HPV-associated OPSCC of TNM stage 1/2, radiotherapy alone, or concurrent chemotherapy resulted in 69.5% five-year recurrence-free survival and overall survival rates [ 218 , 219 ].…”

Genetic and transcriptomic analyses in a rare case of human papillomavirus–related oropharyngeal squamous-cell carcinoma combined with small-cell carcinoma

“…Consequently, there has been a worldwide attempt to reduce the treatment intensity for HPVrelated OPSqCC (Saito et al 2020).…”

“…As a result, in 2017, the American Joint Committee on Cancer TNM classification specified HPV-related OPSqCC as a separate entity and set a lenient classification (i.e., downstaging) to this malignancy ( O'Sullivan et al 2016 ; Machczyński et al 2020 ). Consequently, there has been a worldwide attempt to reduce the treatment intensity for HPV-related OPSqCC ( Saito et al 2020 ).…”