Aimee R Kreimer, Gary M Clifford, Peter Boyle, Silvia Franceschi
Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review.
Cancer Epidemiol Biomarkers Prev. 2005 Feb;14(2):467-75. doi: 10.1158/1055-9965.EPI-04-0551.
Abstract/Text
Mucosal human papillomaviruses (HPV) are the cause of cervical cancer and likely a subset of head and neck squamous cell carcinomas (HNSCC), yet the global prevalence and type distribution of HPV in HNSCC remains unclear. We systematically reviewed published studies of HNSCC biopsies that employed PCR-based methods to detect and genotype HPV to describe the prevalence and type distribution of HPV by anatomic cancer site. Geographic location and study size were investigated as possible sources of variability. In the 5,046 HNSCC cancer specimens from 60 studies, the overall HPV prevalence was 25.9% [95% confidence interval (95% CI), 24.7-27.2]. HPV prevalence was significantly higher in oropharyngeal SCCs (35.6% of 969; 95% CI, 32.6-38.7) than oral SCCs (23.5% of 2,642; 95% CI, 21.9-25.1) or laryngeal SCCs (24.0% of 1,435; 95% CI, 21.8-26.3). HPV16 accounted for a larger majority of HPV-positive oropharyngeal SCCs (86.7%; 95% CI, 82.6-90.1) compared with HPV-positive oral SCCs (68.2%; 95% CI, 64.4-71.9) and laryngeal SCCs (69.2%; 95% CI, 64.0-74.0). Conversely, HPV18 was rare in HPV-positive oropharyngeal SCCs (2.8%; 95% CI, 1.3-5.3) compared with other head and neck sites [34.1% (95% CI, 30.4-38.0) of oral SCCs and 17.0% (95% CI, 13.0-21.6) of laryngeal SCCs]. Aside from HPV16 and HPV18, other oncogenic HPVs were rarely detected in HNSCC. Tumor site-specific HPV prevalence was higher among studies from North America compared with Europe and Asia. The high HPV16 prevalence and the lack of HPV18 in oropharyngeal compared with other HNSCCs may point to specific virus-tissue interactions. Small sample size and publication bias complicate the assessment of the prevalence of HPV in head and neck sites beyond the oropharynx.
Carole Fakhry, Maura L Gillison
Clinical implications of human papillomavirus in head and neck cancers.
J Clin Oncol. 2006 Jun 10;24(17):2606-11. doi: 10.1200/JCO.2006.06.1291.
Abstract/Text
Human papillomavirus (HPV) is now recognized to play a role in the pathogenesis of a subset of head and neck squamous cell carcinomas (HNSCCs), particularly those that arise from the lingual and palatine tonsils within the oropharynx. High-risk HPV16 is identified in the overwhelming majority of HPV-positive tumors, which have molecular-genetic alterations indicative of viral oncogene function. Measures of HPV exposure, including sexual behaviors, seropositivity to HPV16, and oral, high-risk HPV infection, are associated with increased risk for oropharyngeal cancer. HPV infection may be altering the demographics of HNSCC patients, as these patients tend to be younger, nonsmokers, and nondrinkers. There is sufficient evidence to conclude that a diagnosis of HPV-positive HNSCC has significant prognostic implications; these patients have at least half the risk of death from HNSCC when compared with the HPV-negative patient. The HPV etiology of these tumors may have future clinical implications for the diagnosis, therapy, screening, and prevention of HNSCC.
Shanthi Marur, Gypsyamber D'Souza, William H Westra, Arlene A Forastiere
HPV-associated head and neck cancer: a virus-related cancer epidemic.
Lancet Oncol. 2010 Aug;11(8):781-9. doi: 10.1016/S1470-2045(10)70017-6. Epub 2010 May 5.
Abstract/Text
A rise in incidence of oropharyngeal squamous cell cancer--specifically of the lingual and palatine tonsils--in white men younger than age 50 years who have no history of alcohol or tobacco use has been recorded over the past decade. This malignant disease is associated with human papillomavirus (HPV) 16 infection. The biology of HPV-positive oropharyngeal cancer is distinct with P53 degradation, retinoblastoma RB pathway inactivation, and P16 upregulation. By contrast, tobacco-related oropharyngeal cancer is characterised by TP53 mutation and downregulation of CDKN2A (encoding P16). The best method to detect virus in tumour is controversial, and both in-situ hybridisation and PCR are commonly used; P16 immunohistochemistry could serve as a potential surrogate marker. HPV-positive oropharyngeal cancer seems to be more responsive to chemotherapy and radiation than HPV-negative disease. HPV 16 is a prognostic marker for enhanced overall and disease-free survival, but its use as a predictive marker has not yet been proven. Many questions about the natural history of oral HPV infection remain under investigation. For example, why does the increase in HPV-related oropharyngeal cancer dominate in men? What is the potential of HPV vaccines for primary prevention? Could an accurate method to detect HPV in tumour be developed? Which treatment strategies reduce toxic effects without compromising survival? Our aim with this review is to highlight current understanding of the epidemiology, biology, detection, and management of HPV-related oropharyngeal head and neck squamous cell carcinoma, and to describe unresolved issues.
2010 Elsevier Ltd. All rights reserved.
Gregory S Weinstein, Bert W O'Malley, Wendy Snyder, Eric Sherman, Harry Quon
Transoral robotic surgery: radical tonsillectomy.
Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1220-6. doi: 10.1001/archotol.133.12.1220.
Abstract/Text
OBJECTIVE: To describe and show the feasibility of a new surgical technique for transoral robotic surgery (TORS) radical tonsillectomy.
DESIGN: A prospective, phase 1 clinical trial.
SETTING: Academic, tertiary referral center.
PATIENTS: A total of 27 participants were prospectively selected using a volunteer sample. All eligible patients agreed to participate in the study.
INTERVENTIONS: Patients underwent TORS radical tonsillectomy for previously untreated invasive squamous cell carcinoma of the tonsillar region without free-flap reconstruction, staged neck dissection, and adjuvant therapy.
MAIN OUTCOME MEASURES: Outcome measures included final pathologic margin status, need for short- and long-term tracheotomy tube placement, and need for gastrostomy tube feedings among patients with a minimum 6-month follow-up. The incidence of significant postoperative complications was recorded.
RESULTS: No mortality occurred. Final margins found to be negative for cancer were achieved in 25 of 27 patients (93%). Surgical complications included 1 case each of postoperative mucosal bleeding, delirium tremens, unplanned tracheotomy for temporary exacerbation of sleep apnea, and hypernasality and 2 cases of moderate trismus. Twenty-six of 27 patients (96%) were swallowing without the use of a gastrostomy.
CONCLUSIONS: Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity. Future reports will focus on long-term oncologic and functional outcomes.
斉川雅久, 福田諭, 永橋立望,他：統計からみた頭頸部多重がんの実態. 頭頸部腫瘍 29：526-540, 2003.
水町貴諭、畠山博充、加納里志、他：HPV陽性中咽頭癌に対する個別化治療戦略 頭頸部癌37:394-397, 2011.
加藤久幸、油井健宏、岡田達佳、他：Human Papillomavirus(HPV)関連前壁・側壁型中咽頭扁平上皮癌の分子生物学的検討 頭頸部癌36:339-343, 2010.
鬼塚哲郎、海老原 敏、大山和一郎、他：中咽頭扁平上皮癌の治療成績 頭頸部腫瘍 28: 12-17, 2002.
戎本浩史、大上研二、酒井昭博、他：当科における中咽頭扁平上皮癌の治療成績 頭頸部癌 37:405-410, 2011.
日本頭頸部癌学会編：頭頸部癌診療ガイドライン 2022年版.
頭頸部癌取り扱い規約 第6版 日本頭頸部癌学会編.
