HPV Positive Throat Cancer Patients Need Less Neck Surgery

Patients with oropharyngeal cancer (OPC) resulting from human papillomavirus (HPV) show significantly higher rates of complete response on a post-radiation neck dissection, according to a new study.

Researchers at the Fox Chase Cancer Center (FCCC; Philadelphia, PA, USA) reviewed the medical records of 396 patients whose oropharyngeal tumors had spread to at least one lymph node. Within 180 days of completing radiation therapy, 146 of the patients underwent neck surgery to remove persistent lumps in their neck; of these, 99 patients had records that indicated whether or not their tumors had likely been triggered by HPV.

The researchers found that patients with HPV often responded better to treatment for OPC than those without. The same trend suggested that those that tested positive for HPV—measured by the presence of a protein called p16—were less likely to have a recurrence of their cancers, regardless of whether or not the tumors had completely disappeared following treatment. Patients’ HPV status was also the strongest predictor of whether or not they were alive at the end of the study. The study was presented at the American Society for Radiation Oncology (ASRO) annual meeting, held during September 2014 in Chicago (IL, USA).

“Among the patients who underwent neck surgery, any lingering bumps were more likely to be benign if patients were infected with HPV,” said lead author and study presenter Thomas Galloway, MD, director of clinical research at FCCC. “For patients that achieve a complete response, neck surgery is probably unnecessary. The bump might have become a permanent scar, or in some cases, it would have eventually disappeared.”

HPV oral infection precedes the development of the related OPC. Slight injury to the mucous membrane serves as an entry gate for HPV, which thus works into the basal layer of the epithelium. An earlier prospective study found that increased HPV+ OPC risk was observed more than 15 years after HPV exposure, pointing to a slow development of the disease, much like cervical cancer.

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