Staged transoral surgery in synchronous HPV-related oropharyngeal cancer.

Adjuvant treatment in elderly patients undergoing transoral surgery for HPV-related oropharyngeal cancer.

Transoral surgery is an increasingly frequent treatment modality for tumors of the upper aerodigestive tract. This is in large part related to the introduction of transoral robotic surgery (TORS) for oropharyngeal cancer resection, which has demonstrated excellent oncologic and functional outcomes. There is limited data, however, on how TORS compares to traditional open surgery in overall costs and length of hospitalization. With increasing pressure to contain and reduce the costs of medical care, we sought to evaluate the impact of TORS on a national sample of patients undergoing surgery for oropharyngeal cancer. Retrospective cross-sectional study. A cross-sectional analysis of 9,601 patients who underwent an extirpative procedure for a malignant oropharyngeal neoplasm in 2008 to 2009 was performed using discharge data from the Nationwide Inpatient Sample. TORS was performed in 116 (1.2%) of cases. TORS patients had a lower rate of gastrostomy tube placement (0% vs. 19%), tracheotomy tube placement (0% vs. 36%), and nonroutine discharge (0% vs. 44%) compared to patients undergoing non-TORS procedures. After controlling for all other variables, including comorbidity, extent of surgery, and teaching hospital status, TORS was associated with significantly decreased length of hospitalization (mean, -1.5 days) and hospital-related costs (mean, -$4,285). TORS is becoming an increasingly frequent technique to treat tumors of the upper aerodigestive tract. These data demonstrate that TORS is associated with a decreased length of hospitalization and hospital-related costs compared to other surgical techniques.

To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer. A total of 68,445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County-level rurality data and income data were merged using the US Department of Agriculture Rural-Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status. Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6-7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1-1.3). The magnitude of the racial disparity is attenuated with increasing age. We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient's sociodemographic characteristics in healthcare service.

To evaluate the impact of surgeon and hospital case volume and other related variables on short-term outcomes after surgery for oropharyngeal cancer. The Maryland Health Service Cost Review Commission database was queried for oropharyngeal cancer surgical case volumes from 1990 to 2009. Multivariable regression models were used to identify significant associations between surgeon and hospital case volume, as well as independent variables predictive of in-hospital death, postoperative wound complications, length of hospitalization, and hospital-related cost of care. Overall, 1,534 oropharyngeal cancer surgeries were performed during the study period. Complete financial data was available for 1,482 oropharyngeal cancer surgeries, performed by 233 surgeons at 36 hospitals. The only independently significant factors associated with the risk of in-hospital death were an APR-DRG mortality risk score of 4 (odds ratio [OR] = 14.0, P < .001) and total glossectomy (OR = 5.6, P = .020). Wound fistula or dehiscence was associated with an increased mortality risk score (OR = 5.9, P < .001), total glossectomy (OR = 6.9, P < .001), mandibulectomy (OR = 3.4, P < .001), and flap reconstruction (OR = 2.1, P = .038). Increased mortality risk score, total glossectomy, pharyngectomy, mandibulectomy, flap reconstruction, neck dissection, and Black race were associated with an increased length of stay and hospital-related costs. After controlling for all other variables, a statistically significant negative correlation was observed between surgery at a high-volume hospital and length of hospitalization and hospital-related costs. After controlling for other factors, high-volume hospital care is associated with a shorter length of hospitalization and lower hospital-related cost of care for oropharyngeal cancer surgery.

We aim to 1) evaluate trends in adjuvant treatment of human papilloma virus (HPV)-related oropharyngeal cancer; 2) assess change in complications and functional outcomes over time; and 3) assess change in overall and disease-free survival (DFS) over time. Retrospective analysis. Charts of patients who underwent transoral robotic surgery for HPV-related oropharyngeal cancer between 2011 and 2019 were reviewed. Trend analysis was used to compare rate of adjuvant treatment over time. The Kaplan-Meier method was conducted to analyze overall survival (OS) and DFS. Three hundred and forty-two patients met inclusion criteria. One hundred and sixty-three (47.7%) patients underwent adjuvant radiation, and 90 (26.3%) patients underwent adjuvant chemoradiation. Rate of extranodular extension decreased significantly from 38.9% to 24.0% (P =.004). Rate of adjuvant therapy decreased significantly from 90.9% to 62.5% between 2011 and 2019 (P=.001). In patients who received adjuvant treatment, rate of adjuvant chemoradiation therapy decreased significantly from 40.0% to 20.0% (P < .0005). There was a decrease in rate of 1-year gastrostomy tube dependence in patients treated in 2015 to 2019 versus 2011 to 2014 (2.2% vs. 7.1%, P=.025). In 2011 to 2014, 2-year OS and DFS were 96% and 89%, respectively; in 2015 to 2019, 2-year OS and DFS were 96% and 94%, respectively. There was no difference in OS or DFS between the two time periods. The rate of adjuvant therapy, particularly chemotherapy, has decreased over time. One-year gastrostomy tube dependence rate has decreased significantly from 2011 to 2014 to 2015 to 2019. There was no change in OS and DFS over this time period. 3 Laryngoscope, 132:806-812, 2022.

Transfusion of allogenic leukocyte-depleted packed red blood cells is associated with postoperative morbidity in patients undergoing oral and oropharyngeal cancer surgery

&lt;div&gt;Abstract&lt;p&gt;Only a minority of those exposed to human papillomavirus (HPV) develop HPV-related cervical and oropharyngeal cancer. Because host immunity affects infection and progression to cancer, we tested the hypothesis that genetic variation in immune-related genes is a determinant of susceptibility to oropharyngeal cancer and other HPV-associated cancers by performing a multitier integrative computational analysis with oropharyngeal cancer data from a head and neck cancer genome-wide association study (GWAS). Independent analyses, including single-gene, gene-interconnectivity, protein–protein interaction, gene expression, and pathway analysis, identified immune genes and pathways significantly associated with oropharyngeal cancer. &lt;i&gt;TGFβR1&lt;/i&gt;, which intersected all tiers of analysis and thus selected for validation, replicated significantly in the head and neck cancer GWAS limited to HPV-seropositive cases and an independent cervical cancer GWAS. The &lt;i&gt;TGFβR1&lt;/i&gt; containing p38–MAPK pathway was significantly associated with oropharyngeal cancer and cervical cancer, and &lt;i&gt;TGFβR1&lt;/i&gt; was overexpressed in oropharyngeal cancer, cervical cancer, and HPV&lt;sup&gt;+&lt;/sup&gt; head and neck cancer tumors. These concordant analyses implicate &lt;i&gt;TGFβR1&lt;/i&gt; signaling as a process dysregulated across HPV-related cancers. This study demonstrates that genetic variation in immune-related genes is associated with susceptibility to oropharyngeal cancer and implicates &lt;i&gt;TGFβR1&lt;/i&gt;/&lt;i&gt;TGFβ&lt;/i&gt; signaling in the development of both oropharyngeal cancer and cervical cancer. Better understanding of the immunogenetic basis of susceptibility to HPV-associated cancers may provide insight into host/virus interactions and immune processes dysregulated in the minority of HPV-exposed individuals who progress to cancer. &lt;i&gt;Cancer Res; 74(23); 6833–44. ©2014 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

SUMMARYHuman papillomavirus (HPV) infection is a recognised causal factor associated with oropharyngeal cancers. The global burden of HPVrelated oropharyngeal cancers is on the increase and is predicted to surpass the burden of cervical cancer in the near future. As evidence is accumulating on the potential effectiveness of an HPV vaccine in controlling the oropharyngeal cancer epidemic; otorhinolaryngologists assume a key role – not only in the diagnosis and treatment of HPV-related cancers – but also in educating and advocating on HPV prevention. We conducted a survey to assess Italian otorhinolaryngologists' knowledge and attitudes regarding HPV infection, HPV-related oropharyngeal diseases and cancers and available prevention measures, including vaccines. This is the first study conducted in Italy and Europe on this topic. A total of 262 Italian otorhinolaryngologists were recruited during the National Conference of the Italian Association of Otorhinolaryngologists. Our results show that Italian otorhinolaryngologists are knowledgeable regarding HPV infection and have a positive attitude towards HPV vaccine. Our findings provide a useful basis to plan, implement and evaluate targeted educational programmes and training. As we show herein, educational programmes and training specifically focusing on HPV are effective in increasing physicians' knowledge and positive attitudes towards prevention; this ultimately contributes to enhance vaccine uptake among patients and the general population. With the overall aim of controlling the burden of HPV-related cancers, resources and efforts should be devoted to promote continuing education among otorhinolaryngologists and the general medical community and to increase awareness on the role of vaccines in prevention of HPV-related cancers. In this context, there is tremendous opportunity for healthcare providers across fields to cooperate and for public health and otorhinolaryngologist communities to join forces and engage in fruitful collaboration.

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide and is a leading cause of oropharyngeal cancer. This study aimed to carry out a KAP survey on HPV infection, HPV-related oropharyngeal cancer and HPV vaccination among dental students. Methods: Through an online self-administered questionnaire, data on dental students' sociodemographic characteristics, knowledge, attitudes and perceptions concerning HPV-related oropharyngeal cancer, infection and vaccination were acquired for a total of 82 questions. Results: A total of 412 dental students completed the questionnaire. The general knowledge rate was 69.5%. In terms of perception, the students provided good insight into their future role in combating HPV disease. Regarding attitudes, most participants felt comfortable talking about HPV topics with patients; however, only approximately 50% of them were inclined to recommend the vaccine regardless of sex. Compared with male and first-year students, female and last-year degree students demonstrated more positive attitudes and perceptions, respectively. Conclusions: This study revealed that dental students have a solid understanding of and positive attitudes toward and perceptions of HPV+ oropharyngeal cancer and its prevention, highlighting their readiness to incorporate HPV prevention into their practice. This emphasizes the key role of the dental profession in addressing oropharyngeal cancer and HPV-related diseases and promoting awareness of the HPV vaccine among the population. Clinical Relevance: By increasing dental students' awareness of HPV, they may be better equipped to educate patients about HPV, promote vaccination, and implement preventative measures. Additionally, the study highlights the need for targeted educational interventions to improve knowledge and attitudes, to enhance the overall public health impact.

Purpose: Persons living with HIV have elevated risks of HPV-related cervical, anogenital, and oropharyngeal cancers. Yet, research on optimization and implementation of prevention interventions (prophylactic HPV vaccination, cervical and anogenital cancer screening and triage, and precancer therapeutics) for HPV-related cancers among persons living with HIV has been limited. With a goal to expand this evidence, and building on strong academic research partnerships developed for HIV research between institutions in the US and the Latin American and the Caribbean (LAC) region, the US National Cancer Institute (NCI) initiated ULACNet, a new Cooperative Agreement clinical trials network in 2019. Methods: ULACNet comprises of three Partnership Centers each led by US-based institutions (University of California San Francisco, Weill Medical College of Cornell University, and Fred Hutchinson Cancer Research Center), working collaboratively with US and LAC institutions and with the NCI to develop and conduct multicenter prevention clinical trials focused on filling key scientific gaps and evaluating novel interventions. Results: ULACNet encompasses six countries (US, Mexico, Puerto Rico, Brazil, Peru, and Dominican Republic), twenty partner institutions, and over 100 collaborating scientific investigators, clinical and public health practitioners, research staff, and patient advocates. ULACNet will collaboratively conduct nine prevention clinical trials (two prophylactic HPV vaccine trials in adults and perinatally-HIV infected adolescents, three trials for clinical validation of molecular biomarkers and imaging technologies for screening and triage, two candidate HPV therapeutic vaccine trials, and two trials of topical therapeutic agents). Facilitation across network partners is achieved via a Coordinating Committee and three Working Groups (focused on HPV testing and screening, precancer treatment, and recruitment and retention activities). Conclusion: ULACNet seeks to leverage established academic global health partnerships to conduct high quality collaborative clinical trials to inform clinical practice and ultimately reduce the burden of highly preventable HPV-related cancers in persons living with HIV worldwide. Citation Format: Emma Brofsky, Margaret House, Brandy Heckman-Stoddard, Mostafa Nokta, Satish Gopal, Vikrant Sahasrabuddhe. Development of International Cancer Research Partnerships Through the NCI US-Latin American-Caribbean HIV/HPV-Cancer Prevention Clinical Trials Network (ULACNet) [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 20.

The ECOG-ACRIN E3311 Phase II trial demonstrated outstanding disease control (90.6% 54-month PFS) following transoral surgery (TOS) with de-escalated, risk-based postoperative management in resectable HPV-associated oropharyngeal cancer (OPC). The goal of de-escalation was functional preservation. The objective of this work was to evaluate clinician-graded modified barium swallow (MBS) studies from E3311 over time and across arms for: (i) aspiration and high-grade pharyngeal residue rates, (ii) differences in swallow safety and efficiency, and (iii) accuracy of site clinician reporting against central MBS review. 885 MBS studies were performed on 314 patients from 50/59 sites at baseline, post-TOS, and 6- and 24-months post-RT. Swallow outcomes (aspiration, high-grade residue) were recorded by site clinicians. A subset of 414 MBS studies was centrally graded using penetration-aspiration scale (PAS) scores and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Aspiration, residue and dysphagia rates significantly increased from baseline to post-TOS (p<0.01) and then decreased modestly at 6- and 24-months. At 6 months, swallow outcomes favored the 50Gy vs. 60Gy arm, with significantly lower aspiration and high-grade dysphagia rates but this difference was not maintained at 24-months. MBS results reported by site clinicians demonstrated substantial agreement with the central laboratory (PABAK: 0.75-0.84, p<0.01). Swallowing worsened after TOS but improved by 6 and 24 months despite adjuvant therapy. De-escalated adjuvant RT at 50 Gy reduced acute aspiration. Site-reported MBS metrics strongly aligned with DIGEST, showing potential as an accessible metric in cooperative group settings.

Background: HPV plays a significant role in cancers and diseases that impact males directly including penile, oral, and anal malignancies, but awareness and positive vaccine intention in males remain problematic. HPV research largely focuses on cervical cancer prevention, ultimately feminizing HPV and erroneously portraying HPV as an infection that does not affect men. Incidence rates of oropharyngeal and anal cancers associated with HPV are increasing, and these cancers disproportionately affect men. Additionally, racial/ethnic minority men are disproportionately affected by HPV-related diseases and cancers. Black and Hispanic men are diagnosed with more HPV-related cancers and HPV-related cancers at later stages compared to other racial/ethnic groups. To date, very few studies have focused on HPV among racial/ethnic minority men and sexual. The purpose of this study is to examine 1) the awareness of men about HPV and their sexual behaviors and 2) the association of their intent to receive the HPV vaccination and sexual behaviors among racial/ethnic men. Methods: Racial/ethnic minority men age 18 to 27 (n=190) attending a large public university in the southeast US completed a 20-minute web-based survey in the fall of 2011. Survey items were adapted from previous research of psychosocial HPV studies among men and women, and were based on constructs from the Health Belief Model and Social Cognitive Theory. This analysis examined self-reported data on participants' sociodemographics, sexual behavior, HPV knowledge, vaccine status, and intent to receive HPV vaccination. Univariate analyses examined the sample distribution; Bivariate analyses were conducted to examine racial/ethnic differences sexual behavior and intent to receive the HPV vaccination, and binomial logistic regression analysis examined associations between intent to receive HPV vaccination and sexual behaviors. Results: The mean age of the sample was 21.31 (SD=2.579) years. The men identified themselves as Hispanic or Latino/a (49.5%), African-American /Black (17.9%), Asian (13.7%), Other (12.1%), and White (6.8%). The majority of the sample was insured (79.5%), unmarried/single (83.7%), heterosexual (91.1%), and completed 2 years of college or less (45.3%). Frequency distributions indicated that 73.2% did not consider themselves to be virgins and 49.5% of the sample was currently sexually active. In addition, 79.5% of the sample had previous knowledge about HPV, 81.6% of the sample had not received a dose of the HPV vaccine, and 77.1% did not plan to receive the HPV vaccine. Bivariate analyses showed that Hispanic and Black men were less likely to identify as virgins (p=0.03), more likely to have had vaginal (p=0.01) and oral (p=0.045) sex, and more likely to have vaginal sex at an earlier mean age compared to Asian, White, and Other men. Men who reported having had vaginal sex (28.6%; p=0.01), not being virgins (28.1%; p=0.008), and who were currently sexually active (31.8%; p=0.06) were more likely to have intentions of getting the HPV vaccination. Binomial logistic regression analysis showed that men who thought the HPV vaccine was of moderate importance were more likely than men who thought the HPV vaccine was of low and high importance to intend to receive the HPV vaccine (p=0.02). Conclusion: Although this mostly racial/ethnic minority sample of men were knowledgeable about the HPV vaccine and reported being sexually active, they were still less likely to intend to receive the vaccine. Providing information about HPV at early ages, particularly for Black and Hispanic men, and that it is transmitted through the different sexual behaviors may increase and emphasize the importance of HPV vaccination. Determining factors associated with HPV vaccine intentions among those at risk for HPV is important in increasing uptake of the vaccine and decreasing the burden of HPV-related diseases. Citation Format: Dexter L. Cooper, Natalie D. Hernandez, Tiffany Zellner-Lawrence. Examining HPV awareness, sexual behavior, and intent to receive the HPV vaccine among racial/ethnic males 18-27 [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C89.

Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients. To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes. Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 28th July 2010. Reference lists of recent reviews and included studies were also searched to identify further trials. Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included. Trials which met the inclusion criteria were assessed for risk of bias using six domains: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting and other possible sources of bias. Data were extracted using a specially designed form and entered into the characteristics of included studies table and the analysis sections of the review. The proportion of participants in each trial with oral cavity and oropharyngeal cancers are recorded in Additional Table 1. There was no statistically significant improvement in overall survival associated with induction chemotherapy compared to locoregional treatment alone in 25 trials (hazard ratio (HR) of mortality 0.92, 95% confidence interval (CI) 0.84 to 1.00). Post-surgery adjuvant chemotherapy was associated with improved overall survival compared to surgery +/- radiotherapy alone in 10 trials (HR of mortality 0.88, 95% CI 0.79 to 0.99), and there was an additional benefit of adjuvant concomitant chemoradiotherapy compared to radiotherapy in 4 of these trials (HR of mortality 0.84, 95% CI 0.72 to 0.98). Concomitant chemoradiotherapy resulted in improved survival compared to radiotherapy alone in patients whose tumours were considered unresectable in 25 trials (HR of mortality 0.79, 95% CI 0.74 to 0.84). However, the additional toxicity attributable to chemotherapy in the combined regimens remains unquantified. Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy is associated with a 9% increase in survival and adjuvant concomitant chemoradiotherapy is associated with a 16% increase in overall survival following surgery. In patients with unresectable tumours, concomitant chemoradiotherapy showed a 22% benefit in overall survival compared with radiotherapy alone.

Early and late physical and psychosocial effects of primary surgery in patients with oral and oropharyngeal cancers: a systematic review