Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

Beltz, Anna; Zimmer, S; Michaelides, Ioannis; Evert, Katja; Psychogios, Georgios; Bohr, Christopher; Künzel, Julian

doi:10.3389/fonc.2020.01394

Cited by 13 publications

(15 citation statements)

References 55 publications

(144 reference statements)

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“…As mentioned previously, the prognostic role of ENE in p16+ OPC has shown mixed results 3–18 . Although this was not one of our main study objectives, it is interesting to note that on multivariable analysis in our propensity matched cohort, both microscopic and macroscopic ENE were associated with worse OS.…”

Section: Discussionmentioning

confidence: 65%

“…The positive prognostic influence of human papillomavirus (HPV) infection on oropharyngeal carcinoma (OPC) is well established, and many studies have aimed to identify features that may permit treatment de‐escalation 1,2 . The prognostic value of extranodal extension (ENE) in HPV‐mediated OPC is controversial, with conflicting reports 3–18 . Ultimately, the American Joint Committee on Cancer (AJCC) released a separate p16+ staging system which no longer included ENE within the nodal staging system 19,20 .…”

Section: Introductionmentioning

confidence: 99%

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Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

et al. 2021

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Background Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. Methods The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. Results A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56–1.28), ENE (HR 0.93, 95% CI 0.69–1.27) or both (HR 0.73, 95% CI 0.41–1.31). Conclusions In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

et al. 2021

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“…The clinical significance of ENE in HPV+ OPSCC and role for adjuvant chemotherapy remains to be investigated ( 49 ). The AJCC 8 th edition staging for HPV+ OPSCC no longer accounts for ENE.…”

Section: Discussionmentioning

confidence: 99%

Surgical clinical trials for HPV-positive oropharyngeal carcinoma

2022

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The treatment of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) continues to evolve as multiple ongoing and recently completed clinical trials investigate the role of surgery, radiation therapy, chemotherapy, and immunotherapy. Current trials are investigating transoral robotic surgery (TORS) in treatment de-escalation protocols in an effort to optimize quality of life, while maintaining historical survival rates. The advantage of TORS is its minimally invasive approach to primary resection of the tumor as well as valuable pathologic staging. The ORATOR trial reported poorer quality of life in patients treated with TORS compared to primary radiotherapy though this was not a clinically meaningful difference. The recently published ECOG 3311 trial showed that surgery can be used to safely de-escalate the adjuvant radiation dose to 50 Gy in intermediate-risk patients. In this review, we summarize and discuss the past and current clinical trials involving surgery in the treatment of HPV-positive OPSCC.

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“…The prognostic significance of ENE in HPV-positive OPSCC is inconclusive at best. 55 A number of authors stated that ENE does not predict worse clinical behavior. [55][56][57][58][59][60][61] Sinha et al, for instance, suggest that ENE should not be used to justify adjuvant chemotherapy.…”

Section: Indications For Hpv Testing In Pathology Specimens and Detection Methodsmentioning

confidence: 99%

“…55 A number of authors stated that ENE does not predict worse clinical behavior. [55][56][57][58][59][60][61] Sinha et al, for instance, suggest that ENE should not be used to justify adjuvant chemotherapy. 62 In their analysis of 152 patients with HPV-positive OPC with a median follow-up of 43 months, the presence of ENE did not impact diseasefree survival.…”

Section: Indications For Hpv Testing In Pathology Specimens and Detection Methodsmentioning

confidence: 99%

HPV‐related head and neck cancers: Pathology and biology

Saliba

Ghossein

2021

Journal of Surgical Oncology

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Discovering the key role HPV plays in head and neck carcinogenesis has revolutionized our approach to cancers such as oropharyngeal carcinomas. As the role of HPV expands beyond the oropharynx, there is a pursued need to understand the oncogenic mechanisms of HPV-driven tumorigenesis and their implications. Optimizing HPV detection methods all while acknowledging their limitations will ensure our ability to diagnose HPV-driven neoplasia wherever clinically relevant.

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Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas

Cited by 13 publications

References 55 publications

Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

Surgical clinical trials for HPV-positive oropharyngeal carcinoma

HPV‐related head and neck cancers: Pathology and biology

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