Advances in diagnosis and multidisciplinary management of oropharyngeal squamous cell carcinoma: State of the art

Upendra Parvathaneni, Pierre Lavertu, Michael K. Gibson, Christine M. Glastonbury

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

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). 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.

Original languageEnglish (US)
Pages (from-to)2055-2068
Number of pages14
JournalRadiographics
Volume39
Issue number7
DOIs
StatePublished - Nov 1 2019
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Fingerprint

Dive into the research topics of 'Advances in diagnosis and multidisciplinary management of oropharyngeal squamous cell carcinoma: State of the art'. Together they form a unique fingerprint.

Cite this