Advances in the management of squamous cell carcinoma of the head and neck (original) (raw)
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Reviews in medical virology, 2012
Oncogenic human papillomavirus (HPV) is currently recognised as a major risk factor for the development of head and neck squamous cell carcinomas (HNSCC). HPV is mostly detected in tumours arising from the oropharynx and more specifically from the tonsil. HPV-related tumours display clinical and molecular characteristics that are distinct from HPV-unrelated tumours, which are generally induced by alcohol and tobacco abuse. Detection of biologically active HPV in HNSCC has prognostic relevance, which warrants the separate classification of HPV-induced tumours and is a prerequisite for further optimisation of treatment protocols for this distinct group. Current guidelines for the treatment of oropharyngeal squamous cell carcinoma (OPSCC) have not incorporated specific treatment modalities for HPV-related tumours. The development of such treatment options is still in a preclinical phase or in early clinical trials. Recent data on treatment response of OPSCC have been obtained by retros...
Head and Neck Squamous Cell Carcinoma: A Review Article
Post-Graduate Medical Journal of NAMS, 2020
Head and Neck Squamous Cell Cancer (HNSCC) is one of the major health related burdens worldwide, causing high morbidities and significant number of mortalities, accounting for more than 800,000 new cases every year. HNSCC usually develops in males in the 6th and 7th decade. Major risk factors of HNSCC are the consumption of tobacco and alcohol and infection with high-risk types of human papillomavirus. HNSCC often develops from preexisting dysplastic lesions. Particular chromosomal alterations appear to be associated with distinct stages of tumor progression. Management of head and neck cancers is complex and involves multiple modalities therefore a multidisciplinary approach is mandatory. Surgery, radiation and chemotherapy are the backbones of the treatment. Majorities of the patients present in the locoregionally advanced disease. Similarly, almost 10% of newly diagnosed patients present with distant metastatic disease. Almost 60% of these patients even after aggressive, site-specific multimodality therapy, fail locally and up to a 30% develop distant metastases. Targeted therapy and Immunotherapy are recent advances in the management of refractory HNSCC to conventional treatments.
Head and neck cancer--Part 2: Treatment and prognostic factors
BMJ, 2010
In this second of a two part series, we discuss recent advances in the management of cancers of the head and neck. We also discuss the important prognostic factors, including the importance of human papillomavirus (HPV) positivity in the newly discovered HPV related cancers of the head and neck. As before, we have used evidence from national guidelines, randomised trials, and level II-III studies. We have also limited our discussions to squamous cell carcinoma of the head and neck, which constitutes more than 85% of head and neck cancers.
Evolving Treatment Paradigms for Oropharyngeal Squamous Cell Carcinoma
Journal of Global Oncology, 2016
Oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence in the United States and in many countries worldwide primarily as a result of increasing rates of human papillomavirus (HPV) infection. HPV-positive OPSCC represents a distinct disease entity from head and neck squamous cell carcinoma caused by traditional risk factors such as tobacco and alcohol, with different epidemiology, patterns of failure, and expected outcomes. Because patients with HPV-positive OPSCC have a younger median age and superior prognosis compared with their HPV-negative counterparts, they live longer with the morbidity of treatment, which can be severe. Therefore, efforts are under way to de-escalate therapy in favorable-risk patients while maintaining treatment efficacy. Additional work is being undertaken to discover new therapies that may benefit both HPV-positive and HPV-negative patient subsets. Herein, we will review the available data for the evolving treatment paradigms in OPSCC as w...
Current Insights and Progress in the Clinical Management of Head and Neck Cancer
Cancers
Head and neck cancer (HNC), also known as the cancer that can affect the structures between the dura mater and the pleura, is the 6th most common type of cancer. This heterogeneous group of malignancies is usually treated with a combination of surgery and radio- and chemotherapy, depending on if the disease is localized or at an advanced stage. However, most HNC patients are diagnosed at an advanced stage, resulting in the death of half of these patients. Thus, the prognosis of advanced or recurrent/metastatic HNC, especially HNC squamous cell carcinoma (HNSCC), is notably poorer than the prognosis of patients diagnosed with localized HNC. This review explores the epidemiology and etiologic factors of HNC, the histopathology of this heterogeneous cancer, and the diagnosis methods and treatment approaches currently available. Moreover, special interest is given to the novel therapies used to treat HNC subtypes with worse prognosis, exploring immunotherapies and targeted/multi-targete...
Management of HPV-Related Squamous Cell Carcinoma of the Head and Neck: Pitfalls and Caveat
Cancers, 2020
Head and neck squamous cell carcinomas (HNSCCs) are a very heterogeneous group of malignancies arising from the upper aerodigestive tract. They show different clinical behaviors depending on their origin site and genetics. Several data support the existence of at least two genetically different types of HNSCC, one virus-related and the other alcohol and/or tobacco and oral trauma-related, which show both clinical and biological opposite features. In fact, human papillomavirus (HPV)-related HNSCCs, which are mainly located in the oropharynx, are characterized by better prognosis and response to therapies when compared to HPV-negative HNSCCs. Interestingly, virus-related HNSCC has shown a better response to conservative (nonsurgical) treatments and immunotherapy, opening questions about the possibility to perform a pretherapy assessment which could totally guide the treatment strategy. In this review, we summarize molecular differences and similarities between HPV-positive and HPV-neg...
Radiographics, 2019
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. ©
Expert Review of Anticancer Therapy, 2010
Squamous cell carcinoma of the head and neck requires a multidisciplinary management. Risk factors for adjuvant radiotherapy are stage III-IV, perineural involvement or vascular tumor embolism. If there are positive margins or extracapsular extension chemoradiotherapy is needed. For patients with nonresectable disease we recommend treatment with concomitant chemoradiation, although this has important acute and late toxicity. Concomitant EGF receptor inhibitors and taxane-based induction chemotherapy are new strategies under study that have demonstrated some benefits but are not yet the standard treatment. Intensity-modulated radiotherapy allows one to decrease radiation dose to organs. Preclinical work in signaling pathways and other oncogenic factors (e.g., human papillomavirus infection) will be the key to improving outcomes of head and neck cancer patients in the future.
NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017
Journal of the National Comprehensive Cancer Network : JNCCN, 2017
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the head and neck (H&N), and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding the increase in human papillomavirus-associated oropharyngeal cancer and the availability of immunotherapy agents for treatment of patients with recurrent or metastatic H&N cancer.