Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16

Abstract

Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16INK4a undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.

The Lack of Standardized Outcomes for Surgical Salvage of HPV-Positive Recurrent Oropharyngeal Squamous Cell Carcinoma: A Systematic Scoping Review

“…Most of the studies presented detailed demographics for subjects with a primary diagnosis of HPV-positive OPSCC [25,26,[33][34][35][36][38][39][40]42,44,45,[48][49][50][51], while others assessed those with recurrence only [11,12,24,27,28,30,32,41,46]. In six studies, either initial or additional demographic information specific to surgically salvaged patients was presented [13,14,29,31,43,47].…”

Significant enhancement of swallowing function and oral hygiene following multidisciplinary team nursing in tongue cancer patients after radical resection

“…Radical resection of tongue cancer (TC) is the main treatment for TSCC [9], which often leads to functional and appearance deficits of the tongue, and a lower quality of life (QoL) after operation [10]. Current nursing methods after such surgery often struggle with challenges such as large oral wounds, increased blood exudation, and decreased oral cleaning ability caused by the use of vasodilators after operation [11,12].…”

Special Issue “HPV in the Head and Neck Region 2.0”

“…Recently, we presented a Special Issue on “HPV in the head and neck region” which included several contributions to the overall knowledge of HPV in the head and neck region. In this second “Special Issue on HPV in the head and neck region 2.0”, eight original articles, one review, and one systematic review are presented [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…A seventh original article investigated the value of post-treatment neck dissection (ND) after tonsillar and base tongue cancer in the Era of PET-CT, HPV, and p16 [ 7 ]. The prevalence and localisations of viable tumour cells in neck lymph nodes were identified by fluorodeoxyglucose positron-emission tomography with computer tomography (FDG PET-CT).…”

“…FDG PET-CT data were compared with the findings in the pathology report after the ND. The authors concluded that FDG PET-CT, 12 weeks after initial treatment, was useful but not entirely reliable for locating all metastases of HPV+ TSCC/BOTSCC; nevertheless, the data indicate that an ND could be more selectively guided by FDG PET-CT [ 7 ].…”