From the Department of Radiation Oncology, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195-6043 (U.P.); Ear Nose and Throat Institute, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio (P.L.); Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tenn (M.K.G.); and Department of Radiology, University of California, San Francisco, San Francisco, Calif (C.M.G.).
Radiographics. 2019 Nov-Dec;39(7):2055-2068. doi: 10.1148/rg.2019190007. Epub 2019 Oct 11.
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). HPV-driven 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.RSNA, 2019.
在过去的十五年中，口咽鳞状细胞癌（OPSCC）最常见的病因已从烟草和酒精转变为人乳头瘤病毒（HPV）。HPV 驱动的 p16 阳性 OPSCC 和与烟草相关的 OPSCC 在其潜在的分子和遗传特征、社会经济人口统计学以及对治疗的反应方面存在差异。HPV 相关的 OPSCC 往往发生在年轻患者中，对治疗的反应明显更好，预后极佳。由于 HPV 相关的 p16 阳性 OPSCC 的总 5 年生存率约为 90%，而非 HPV 相关的 p16 阴性 OPSCC 的生存率为 40%，两者的预后差异巨大，这促使 AJCC（美国癌症联合委员会）分期手册的第八版发生了重大变化。过去的 10-15 年，手术、放射治疗（RT）和系统治疗也取得了重大进展。微创手术已经成熟，包括经口机器人手术和激光微创手术。强度调制 RT（IMRT）和最近的质子束 RT 极大地提高了 RT 的一致性，能够精确瞄准癌症和携带癌症的区域，同时保护正常结构，显著降低长期治疗相关的发病率。系统治疗的进展体现在免疫治疗和靶向药物如西妥昔单抗上。由于 HPV 驱动的 OPSCC 的预后较好，以及与治疗相关的发病率较高，正在通过多种策略探索治疗的降级。本文综述了 HPV 时代 OPSCC 的诊断和多学科管理方面的进展。RSNA，2019 年。
