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| Foreword: HPV and Head and Neck Cancer | p. ix |
| Preface: HPV-Associated Head and Neck Cancers | p. xi |
| Epidemiology of Human Papillomavirus-Related Head and Neck Cancer | p. 739 |
| Human papillomavirus (HPV) is now recognized to cause a subset of head and neck squamous cell carcinomas (HNSCC). Although excessive tobacco and alcohol use continue to be important risk factors for HNSCC, epidemiologic studies suggest that more than 25% of HNSCC are now caused by HPV. The incidence of HPV-related HNSCC is increasing, highlighting the need to understand the oral HPV infections causing these cancers. This article reviews the evidence for a causal association between HPV and HNSCC, examines the changing epidemiologic trends of HNSCC, and discusses what is currently known about oral HPV infection, natural history, and transmission. | |
| Detection of Human Papillomavirus in Clinical Samples | p. 765 |
| The confirmation of human papillomavirus (HPV) as a causative agent for a subset of squamous cell carcinomas of the head and neck has resulted in a growing expectation for HPV testing in head and neck cancers. An increasing understanding of HPV-related tumorigenesis has informed this evaluation process in a manner that is moving wide scale, indiscriminant, and nonstandardized testing toward a more directed, clinically relevant, and standardized approach. This review addresses the current state of HPV detection and focuses on the importance, appropriate time, and need for HPV testing. | |
| Clinical Features of HPV-Related Head and Neck Squamous Cell Carcinoma: Presentation and Work-Up | p. 779 |
| Head and neck squamous cell carcinoma (HNSCC) that arises as a result of the activity of human papillomavirus (HPV) malignant transformation has a distinct disease pattern that is the basis for its clinical presentation. A clear understanding of these distinct clinical features enables diagnosticians to maintain awareness and index of suspicion to avoid delays in detection and select the most effective and thorough measures of evaluating the disease and directing treatment selection. Attention is focused on the broader demographic at risk for developing HPV-related HNSCC, the phenomenon of cystic cervical nodal metastases, and the unknown or occult primary cancer. | |
| Impact of HPV-Related Head and Neck Cancer in Clinical Trials: Opportunity to Translate Scientific Insight into Personalized Care | p. 795 |
| Patients with human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx (SCCOP) enjoy better treatment outcomes than patients suffering from HPV-negative head and neck cancer. To maintain the integrity and utility of future clinical trials, HPV-positive SCCOP must be studied as a distinct entity. The discovery of HPV-positive disease has (1) convoluted comparison of current phase II trial data to historical controls, (2) made formal stratification for HPV infection status an imperative for future phase III trial design, and (3) drawn focus toward opportunities for personalization of treatment intensity. This review discusses these research issues. | |
| Biology of Human Papillomavirus Infection and Immune Therapy for HPV-Related Head and Neck Cancers | p. 807 |
| This article outlines the biology of human papillomavirus (HPV) infection of human mucosa and the cellular pathways that are altered through viral infection. The article provides a conceptual framework with which to understand the 2 major immunologic strategies to address HPV-related diseases: (1) prevention of primary HPV infection through the use of prophylactic vaccines and (2) treatment of established infection and diseases through therapeutic vaccines. Nonimmunologic therapy that targets cellular dysregulation induced by HPV infection is also discussed. The challenges in actualizing these conceptually attractive therapies on both a societal and biological level are examined. | |
| Transoral Endoscopic Surgery: New Surgical Techniques for Oropharyngeal Cancer | p. 823 |
| Surgery of oropharyngeal cancer has evolved from large, open transcervical and transmandibular approaches to minimally invasive transoral endoscopic techniques. Transoral laser microsurgery and transoral robotic surgery allow complete oncologic resection through the mouth with minimal cosmetic deformity and optimal speech and swallow function. With a significant increase in the incidence of oropharyngeal cancers, there is a growing role for up-front surgery, especially in young, healthy patients with human papillomavirus-associated squamous cell carcinoma. This article explores the development of transoral endoscopic surgery, its role in the multidisciplinary treatment of patients with oropharyngeal cancer, and oncologic and functional outcomes. | |
| Treatment Deintensification Strategies for HPV-Associated Head and Neck Carcinomas | p. 845 |
| Past treatment efforts for head and neck squamous cell carcinomas have emphasized treatment intensification that increased local-regional control rates with an increased risk of late (swallowing) complications. With the improved survival demonstrated for human papillomavirus-related oropharyngeal carcinomas, strategies offering comparable outcomes but with fewer complications are needed. Radiotherapy dose reduction has been postulated to reduce the risk of late complications and is an active area of investigation. Alternative strategies may include the use of transoral surgery offering selective use of adjuvant therapy. This article summarizes the contributing risk factors of late swallowing complications and the strategies for risk reduction. | |
| Rehabilitation Needs of Patients with Oropharyngeal Cancer | p. 863 |
| Swallowing and swallowing-related impairments present important post-treatment challenges in individuals undergoing organ preservation therapy for head and neck cancer. Literature pertinent to this topic is reviewed. A protocol for treatment of speech and swallowing deficits related to oropharyngeal cancer and treatment performed at Johns Hopkins Hospital is described. Data collected from a sample of oropharyngeal patients with cancer, with and without human papillomavirus-related disease, are summarized. Future directions for further study of this population are discussed. | |
| The Psychosocial Care Needs of Patients with HPV-Related Head and Neck Cancer | p. 879 |
| Patients with head and neck cancer (HNC) suffer disproportionate psycho social distress because of the nature of the tumor site, the possible impact on facial appearance and function, and the symptom burden resulting from treatment. Unmet psychosocial needs can negatively impact many aspects of care, from compliance to successful survivorship. This article reviews the challenges that patients with HNC confront throughout the disease trajectory from diagnosis to treatment, recovery, and long-term survivorship. It also provides a framework for understanding psychosocial adjustment and quality of life both for the general population of patients with HNC, and those with human papillomavirus-related diagnoses. | |
| Economic Impact of Human Papillomavirus-Associated Head and Neck Cancers in the United States | p. 899 |
| Cases of human papillomavirus (HPV)-associated head and neck cancers are rapidly increasing in the United States. Little is known about the economic burden of these cancers. A literature review identified 7 studies that characterized aspects of the overall economic burden of HPV-associated head and neck cancers in the United States. Other cost studies are detailed to highlight the clinical reality in treating these patients. As the clinical awareness of the role of HPV in head and neck cancers continues, the economic impact of cancers caused by this virus will have implications for the role of various preventive measures. | |
| Index | p. 919 |
| Table of Contents provided by Ingram. All Rights Reserved. |
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