INTRODUCTIONIn the United States, 16 420 patients were diagnosed with oropharyngeal squamous cell carcinoma (SCC) in 2015, and the incidence is increasing steadily due to the human papillomavirus (HPV) epidemic. This viral infection of oropharyngeal crypts is the precursor to oncogenic transformation in >60% of oropharyngeal SCC cases, in contrast to the previous paradigm of oropharyngeal SCC induction from tobacco exposure, with distinctive molecular, clinicopathologic, and prognostic characteristics. The HPV‐negative oropharyngeal SCC displays 25% lower 3‐year overall survival (OS; 57% vs 82%; P < .001) compared to HPV‐positive disease, with HPV status being the single most influential prognostic factor for patients with oropharyngeal SCC. Enhanced radiosensitivity and antitumor immune response potentially explain the improved outcomes in HPV‐positive oropharyngeal SCC, which potentially justifies tailoring treatment based on this marker. Indeed, treatment deintensification is currently being tested in HPV‐positive oropharyngeal SCC through elimination/substitution of traditional cisplatin chemosensitization and/or radiation dose reduction.Along with the oropharyngeal SCC epidemiologic shift, advances in surgical technique reintroduced transoral laser microsurgery and introduced transoral robotic surgery (TORS) into the management paradigm. In contrast to the open surgical approach, these minimally invasive surgeries eliminate the mandibulotomy or pharyngotomy that resulted in significant morbidity with traditional surgical approaches. Primary approaches using TORS,
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck – Wiley
Published: Jan 1, 2018
Keywords: ; ; ;
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