Therapeutic strategies: Surgery for human papillomavirus‐associated oropharyngeal carcinoma

Abstract

Treatment of oropharyngeal cancer (OPC) has undergone considerable evolution since the discovery of human papillomavirus (HPV)-associated OPC. It is widely understood that HPV OPC affects a younger population and standard treatment offers improved oncologic outcomes compared with non-HPV OPC but can cause significant toxicities and long-term side effects. Surgery for treatment de-escalation is an active area of research. The purpose of this review is to explore surgery as it relates to the treatment of HPV OPC with a focus on the evolution of treatment, rationale for surgery, surgical techniques, outcomes, and the role of surgery in deescalation of treatment.

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

“…As a cancer treatment with curative potential, SS is a favorable option for patients with relapsed disease [10]. However, competing interests must be balanced when considering SS, such as the chance for improved survival versus surgical morbidity, which is pronounced with surgical salvage; this includes fibrosis, nerve injury, need for vascularized reconstruction, and wound dehiscence, all which can lead to swallowing dysfunction and potential tracheotomy dependence [7,9,53]. These risks must be balanced against survival benefits.…”

“…Previous studies have either failed to address the role of HPV status in recurrent OPSCC or acknowledged the lack of strong evidence available [5,6,8,9]. It has been labelled as a potential positive prognosticator in SS [10], yet the current literature is ambiguous about the role of HPV status on survival outcomes of SS, with some reports of positive effects [11,12] and others with no impact [13,14].…”