Symposium on Neoplastic Hematology and Medical OncologyHead and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment
Section snippets
Clinical Issues in HNSCC
With the recognition of high-risk HPV infection (primarily type 16) as a risk factor for development of HNSCC and its prognostic importance, there is increasing interest in approaching HNSCC as 2 distinct types, HPV-positive and HPV-negative disease. This distinction is driving advances in our understanding of the biology, mutational landscape, predictors of response to treatment, and survival outcomes for these 2 distinct types of HNSCC.
De-escalation of the current standard chemoradiation
HPV Testing
There is a distinct biology and molecular phenotype among HPV-positive OPSCCs when compared with HPV-negative HNSCCs (Table 1).11, 12 It is critical to understand the HPV types and their role in carcinogenesis. Human papillomavirus is a small-DNA virus with predilection to cutaneous or mucosal squamous epithelium located in the cervix, anogenital region, and a subset of HNSCCs arising from the oropharynx.13, 14 The oncogenic types HPV-16, HPV-18, HPV-31, and HPV-33 are sexually transmitted and
Treatment Advances in HNSCC
Surgery, radiation, and chemotherapy in various combinations are utilized in the management of HNSCC, depending on TNM stage and primary site.3, 26 Limited or early-stage disease (stage I and II) is the presenting stage in approximately 40% of patients and is usually treated with surgery or radiation alone.3, 26 For most patients with locally advanced disease (stage III and IVA/B), resectable or unresectable, treatment entails platinum-based chemoradiation, with or without induction
Conclusion
The growing burden of OPSCC in the United States has important public health and clinical implications. It is important to recognize HPV-negative and HPV-positive HNSCC as 2 biologically and clinically distinct entities, with HPV-positive tumors having more favorable survival outcomes. This difference has resulted in the formulation of risk stratification parameters for prognosis. Current clinical trials are using risk stratification to define eligibility for evaluation of deintensification
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