The management of oropharynx cancer in the HPV era


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Terry Jones1
1Institute of Translational Medicine, University of Liverpool

Abstract

Over recent decades the incidence of oropharynx cancer (OPSCC) has doubled in many countries of the Developed World. Whilst much of this increase has been attributed to infection with Human papillomavirus (HPV+), recent UK data confirms a parallel rise in HPV negative OPSCC.

HPV+ OPSCC affects patients who are younger, fitter, drink less alcohol and smoke less than patients presenting with HPV- head and neck cancer. Whilst they typically present with clinico-pathological features (multiple cervical lymph nodes with a high prevalence of extracapsular spread) traditionally associated with aggressive behaviour and poor treatment outcome, they, paradoxically, respond better to treatment. Current treatments based on cisplatin based chemoradiotherapy (CRT), however, result in marked early and late toxicity, particularly with respect to swallowing function. Whilst most patients with HPV+ disease will experience a favourable survival outcome, a significant minority, together with patients presenting with HPV- disease, will do less well.

This talk will highlight the contribution of contemporary minimally invasive transoral surgery in the quest to develop novel

  1. De-intensified treatment strategies for patients with favourable disease, in order to maintain current survival outcomes whilst reducing detrimental treatment-related effects on swallowing
  2. More effective strategies for patients likely to experience a poorer outcome.

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