Human Papillomavirus-Associated Head and Neck Cancer

Juan C. Nogues, BS; Scott Fassas, MD; Collin Mulcahy, MD; Philip E. Zapanta, MD


J Am Board Fam Med. 2021;34(4):832-837. 

In This Article


Trends in the treatment of patients with OPSCC are constantly evolving. Historically, large open resections were the predominant treatment approach for these patients. Due to severe functional morbidity and high complication rates associated with these invasive procedures, chemoradiation (CRT) became the preferred treatment option in the 1990s.[26] CRT provides equivalent overall survival for patients with OPSCC with less functional morbidity when compared with open surgery. Unfortunately, as CRT became more widely adopted, it was clear that it had its own toxicity profile, including dysphagia, osteoradionecrosis, mucositis, and xerostomia, all which have profound effects on the quality of life for cancer survivors.[27] With the rise in HPV-related OPSCC, and a much younger population being affected, it was imperative to consider the long-term consequences of the treatment regimen. This in part is why treatment again shifted toward less invasive surgical approaches such as transoral robotic surgery (TORS). TORS has been shown to have equivalent outcomes as CRT, and it may allow for improved long-term outcomes from CRT de-escalation.[28] Currently, there is literature to support improved quality of life in patients treated with TORS,[29,30] although the subject at the moment is controversial. Recently the ORATOR trial, a phase 2 randomized study demonstrated that patients undergoing TORS actually had worse swallowing-related quality of life scores 1 year after treatment, compared with the radiotherapy-treated group.[31]