TY - JOUR
T1 - Advances in diagnosis and multidisciplinary management of oropharyngeal squamous cell carcinoma
T2 - State of the art
AU - Parvathaneni, Upendra
AU - Lavertu, Pierre
AU - Gibson, Michael K.
AU - Glastonbury, Christine M.
N1 - Publisher Copyright:
© RSNA, 2019.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - 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). HPVdriven 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.
AB - 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). HPVdriven 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.
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U2 - 10.1148/rg.2019190007
DO - 10.1148/rg.2019190007
M3 - Article
C2 - 31603733
AN - SCOPUS:85074673679
SN - 0271-5333
VL - 39
SP - 2055
EP - 2068
JO - Radiographics
JF - Radiographics
IS - 7
ER -