Richard Ni
John Norfleet
Brian Myung Chang
| Richard Ni | John Norfleet | Brian Myung Chang |
Richard Ni, John Norfleet
Brian Myung Chang
Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine
Introduction
Human papillomavirus is the most common sexually transmitted infection in the United States, with 24 million active cases and 5.5 million new cases annually. HPV positive oropharyngeal cancers have been found to require different treatment and have different survival than cancers that are HPV negative. The American Joint Committee on Cancer (AJCC), has updated their Cancer Staging Manual to the 8th edition to differentiate HPV status of oropharyngeal cancers to reflect these findings. The goal of this literature review is to highlight the changes in treatment and survival of HPV positive oropharyngeal cancer. It is important for both general dentists and specialists to understand these effects on their patients.
Methods
All English articles related to oropharyngeal cancer treatment protocol and HPV associated oropharyngeal cancer were queried using PubMed, UPenn Franklin, and the Cochrane library up to March 2022. The search terms used were “oropharyngeal cancer treatment”, “HPV risk factors”, “HPV oropharyngeal cancer survival”, “oral cancer HPV epidemiology”, “HPV oral cancer treatment protocol”, “HPV oral cancer prevention”.
Results
The preliminary search returned 4253 articles, 30 of which were used to identify aspects of HPV effect on oropharyngeal cancer treatment and survival, compared to non-HPV associated oropharyngeal cancer. The following factors were identified and focused on: epidemiology, treatment protocol, survival, prevention.
Conclusion
While infections with HPV are largely asymptomatic, it is associated with increased risk of oropharyngeal cancer. Between 1988 and 2004, the incidence of HPV negative cancer decreased by 50% while HPV positive cancer increased by 225%. Despite the frequent nodal involvement, HPV-positive OPSCC has a better prognosis than HPV-negative OPSCC. This improved survival rate has led to changes in treatment of OPSCC and investigations into the de-escalation of therapy and whether or not this maintains survival while decreasing long-term complications. There are two approved vaccines that target HV serotypes including p16+ for prevention of cervical cancer and not studied in the prevention of HPV-positive OPSCC. It is likely that these vaccines could help lower the risk of OPSCC in patients that have not yet been infected with HPV.