Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the Art.

Abstract

During the past decade and a half, the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) has shifted from tobacco and alcohol to the human papillomavirus (HPV). HPV-driven p16-positive OPSCC and tobacco-related OPSCC differ in their underlying molecular and genetic profiles, socioeconomic demographics, and response to treatment. HPV-related OPSCC tends to occur in younger patients and has a significantly better response to treatment and excellent prognosis. The stark contrast in prognosis-with around 90% overall 5-year survival for HPV-related p16-positive OPSCC and 40% for non-HPV-related p16-negative OPSCC-has prompted major changes in the eighth edition of the staging manual of the AJCC (American Joint Committee on Cancer). The past 10-15 years have also witnessed major advances in surgery, radiation therapy (RT), and systemic therapy. Minimally invasive surgery has come of age, with transoral robotic procedures and laser microsurgery. Intensity-modulated RT (IMRT) and more recently proton-beam RT have markedly improved the conformity of RT, with an ability to precisely target the cancer and cancer-bearing regions while sparing normal structures and significantly reducing long-term treatment-related morbidity. Progress in systemic therapy has come in the form of immunotherapy and targeted agents such as cetuximab. Owing to the better prognosis of HPV-driven OPSCC as well as the morbidity associated with treatment, de-escalation of therapy via multiple strategies is being explored. The article reviews the advances in diagnosis and multidisciplinary management of OPSCC in the HPV era.©RSNA, 2019.

• Authors: Upendra Parvathaneni, Pierre Lavertu, Michael K Gibson, Christine M Glastonbury
• Journal: Radiographics : a review publication of the Radiological Society of North America, Inc (Radiographics) 2019 Nov-Dec Vol. 39 Issue 7 Pg. 2055-2068 ISSN: 1527-1323 [Electronic] United States
• PMID: 31603733 (Publication Type: Journal Article, Review, Webcast)

Chemical References

• E6 protein, Human papillomavirus type 16
• Oncogene Proteins, Viral
• Papillomavirus E7 Proteins
• Repressor Proteins
• oncogene protein E7, Human papillomavirus type 16

Topics

• Age Distribution
• Alcohol Drinking (adverse effects)
• Carcinoma, Squamous Cell (diagnostic imaging, epidemiology, therapy, virology)
• Cell Cycle
• Chemotherapy, Adjuvant
• Clinical Trials as Topic
• Combined Modality Therapy
• Diagnostic Imaging (methods)
• Disease Management
• Human papillomavirus 16 (pathogenicity)
• Humans
• Immunotherapy
• Lymphatic Metastasis (diagnostic imaging)
• Neoplasm Staging
• Oncogene Proteins, Viral (physiology)
• Oral Surgical Procedures
• Oropharyngeal Neoplasms (diagnostic imaging, epidemiology, therapy, virology)
• Papillomavirus E7 Proteins (physiology)
• Papillomavirus Infections (diagnostic imaging, epidemiology, virology)
• Prognosis
• Radiotherapy, Adjuvant
• Repressor Proteins (physiology)
• Risk Factors
• Salvage Therapy
• Smoking (adverse effects)