This document discusses HPV-related head and neck cancer. It outlines that HPV is associated with 70% of oropharyngeal cancers. Major studies showed HPV-positive head and neck cancers have better responses to chemotherapy and radiation compared to HPV-negative cancers. The 2018 AJCC staging system incorporated HPV status. Guidelines recommend surgery or chemoradiotherapy as primary treatments, with some studies exploring de-intensified treatments for HPV-positive cancers. HPV vaccination can help prevent HPV-related head and neck cancers.

1. HPV Related Head & Neck
Malignancy
Presenter: Dr. Abhijeet S
Moderator: Dr. Deepak S
AIIMS

2. Outline
• Historical trend
• Basics of Human Papilloma Virus
• Major Studies on HPV Positive HNSCC
• HPV +ve VS -ve HNSCC
• AJCC 8th Edition Changes
• Current NCCN Guidelines
• Surgery VS Chemoradiotherapy as treatment modality
• De-intensification Strategy
• HPV Vaccine

5. Human Papilloma Virus
• Papillomaviridae
• Non enveloped
• Double stranded circular DNA
• 8000 kilo base pair
• Cancers caused
• Cervical: 100%
• Anal: 95%
• Oropharyngeal: 70%
• Vaginal: 65%
• Vulval: 50%: 5%

9. TAX 323 Sub group Analysis
*Vermorken JB et al N Engl J Med. 2007;357(17):1695‐1704.

10. HPV Positive Vs HPV Negative HNSCC

11. AJCC Staging Modification

13. +ve vs _ve

14. Gui
d
el
i
n
es
Index
Head
and
Neck
Cancers
TOC
Stagi
n
g,
MS,
References
Practice
Guidelines
in
Oncology
–
v.2.2008
NCCN
®
Note:
All
recommendations
are
category
2A
unless
otherwise
indicated.
Clinical
Trials:
NCCN
believes
that
the
best
management
of
any
cancer
patient
is
in
a
clinical
trial.
Participation
in
clinical
trials
is
especially
encouraged.
Base
of
tongue/tonsil/posterior
pharyngeal
wall/soft
palate
CLINICAL
STAGING
T1-2,
N0-1
Any
T,
N2-3
T3-4a,
N+
T3-4a,
N0
WORKUP
·
·
·
·
·
·
·
·
H&P
Biopsy
HPV
testing
suggested
Chest
imaging
CT
with
contrast
or
MRI
recommended
for
primary
and
neck
Dental
evaluation,
including
panorex
as
indicated
Speech
&
swallowing
evaluation
as
indicated
Examination
under
anesthesia
with
endoscopy
Preanesthesia
studies
·
Multidisciplinary
consultation
as
indicated
See
Treatment
of
Primary
and
Neck
(ORPH-2)
See
Treatment
of
Primary
and
Neck
(ORPH-3)
See
Treatment
of
Primary
and
Neck
(ORPH-4)
Unresectable
See
Treatment
of
Head
and
Neck
Cancer
(ADV-1)
Cancer
of
the
Oropharynx
Head
and
Neck
Cancers

23. Surgery vs Chemo-radiotherapy

28. *Golusin ́ ki t l (2019) Current Role of Surgery in the Management of Oropharyngeal Cancer. Front. Oncol. 9:388.
CONTRAINDICATION TO TOS

29. De-intensification Strategy

33. HPV Vaccine
Cervarix
• Bivalent
• HPV 16, 18
• FDA approved in 2010
• 0.5 ml IM (0/1/6 Month)
• Females only (9-26 year)
Gardasil
• Quadrivalent
• HPV 6, 11, 16, 18
• FDA approved in 2006
• 0.5 ml IM (0/2/6 Month)
• Females and males (9 to 26 year)