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HPV and p16 Testing in Oropharyngeal Squamous Cell Carcinoma

Methodology, Interpretation, and Significance



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Management Strategies in OPSCC

Slide 8

March 2012

Primary chemoradiation is considered the standard of care nationally, with surgery often performed as salvage treatment. In our practice at the Mayo Clinic, however, surgery is the treatment mainstay for most cases of oropharyngeal squamous cell carcinoma. Clear margins, as in many settings of head and neck cancer, is the primary goal so frozen section to evaluate clearance is not uncommon.

Clinical stage 1 and 2 patients (ie patients with small tumors and no lymph node involvement) are often treated with surgery alone.

Clinical stage 3 and 4 patients almost invariably receive radiation. The side effects of radiation are worth considering; fibrosis and scarring may lead to swallowing difficulty, hypothyroidism, and neck pain.

Chemotherapy is reserved for patients with positive surgical margins or extranodal spread. As you would expect, adding chemotherapy to a treatment regimen may come at the expense of adverse events. Cisplatin, the agent most commonly used, can aggravate the side effects of radiation. It may cause nausea, vomiting, and decreased blood counts. The long-term effects of Cisplatin are renal dysfunction, neuropathy, and ototoxicity.

In general, patients are considered to have a significant improvement in survival when treated with post-operative adjuvant therapy. Concurrent chemoradiotherapy has traditionally been considered to offer a better survival benefit when compared to radiotherapy alone. However, recent studies have argued that, in the setting of HPV-associated oropharyngeal squamous cell carcinoma, there is no benefit to adding chemotherapy to the post-operative treatment regimen. This is not an unsettled issue, however, and is certainly something to keep an eye on.

Currently, at the Mayo Clinic, HPV-positive and negative patients are treated essentially the same. However, considerations are being given to deescalating treatment intensity given the less aggressive behavior of HPV-associated oropharyngeal squamous cell carcinoma.

In terms of targeted therapy, cetuximab, a monoclonal antibody directed against the EGFR receptor, is currently being used in Phase III trials. Immunotherapy and vaccines may play a role in the management of oropharyngeal squamous cell carcinoma in the future but are not currently being used.

Management Strategies in OPSCC
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