Guo Theresa, Kang Stephen Y, Cohen Ezra E W
Department of Otolaryngology-Head and Neck Cancer, Moores Cancer Center, University of California, San Diego, San Diego, CA, United States.
Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State University, Columbus, OH, United States.
Front Oncol. 2022 Aug 18;12:966899. doi: 10.3389/fonc.2022.966899. eCollection 2022.
In the recent years, the prevalence of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) has increased significantly. Currently, nearly 80-90% of all oropharynx tumors are HPV-positive. In addition, it is now recognized that HPV-positive tumor status is associated with good prognosis and improved response to chemoradiation. However, within this setting, there are still patients with HPV-positive OPSCC who will experience recurrence. With the increasing incidence of HPV-mediated OPSCC, recurrent HPV disease is also becoming more prevalent and there is an increasing need to understand the unique presentation and treatment of recurrent HPV-mediated disease. In this review, we will discuss epidemiology of recurrent HPV-positive OPSCC, role of surgical salvage, re-irradiation, and the role of upcoming novel treatments and immunotherapy. Historically, recurrent oropharyngeal disease has been associated with poor prognosis and high morbidity. However, recent advances have transformed the landscape for salvage treatment of HPV-mediated OPSCC. Liquid biomarkers offer potential for early detection of recurrence, robotic techniques may reduce morbidity of surgical salvage, improvements in re-irradiation approaches reduce toxicities, and novel immune based therapies on the horizon are offering promising results. These advances combined with the improved prognosis of HPV-positive disease offer to transform our approach to recurrent disease of the oropharynx.
近年来，人乳头瘤病毒（HPV）阳性的口咽鳞状细胞癌（OPSCC）的患病率显著增加。目前，所有口咽肿瘤中近80-90%为HPV阳性。此外，现在已经认识到HPV阳性肿瘤状态与良好的预后以及对放化疗的反应改善相关。然而，在这种情况下，仍有HPV阳性的OPSCC患者会出现复发。随着HPV介导的OPSCC发病率的增加，复发性HPV疾病也越来越普遍，越来越需要了解复发性HPV介导疾病的独特表现和治疗方法。在这篇综述中，我们将讨论复发性HPV阳性OPSCC的流行病学、手术挽救、再照射的作用以及即将出现的新治疗方法和免疫疗法的作用。从历史上看，复发性口咽疾病与预后不良和高发病率相关。然而，最近的进展改变了HPV介导的OPSCC挽救治疗的局面。液体生物标志物为复发的早期检测提供了潜力，机器人技术可能降低手术挽救的发病率，再照射方法的改进降低了毒性，即将出现的新型免疫疗法也取得了令人鼓舞的结果。这些进展与HPV阳性疾病预后的改善相结合，有望改变我们对口咽复发性疾病的治疗方法。
