Published online Oct 10, 2014. doi: 10.5306/wjco.v5.i4.781
Revised: April 21, 2014
Accepted: May 15, 2014
Published online: October 10, 2014
Head and neck cancer (HNC) arises from the skull base to the clavicles and is the fifth most common cancer in the world by incidence. Historically, in the developed world HNC was associated with tobacco use and alcohol consumption, and the combination of the two produced a synergistic increase in risk. However, beginning in 1983, investigators have found a significant and growing proportion of HNC patients with human papillomavirus-positive (HPV) tumors who neither drank nor used tobacco. Since that time, there has been increased interest in the molecular biology of HPV-positive HNC. Multiple studies now show that HPV has shifted the epidemiological landscape and prognosis of head and neck squamous cell carcinoma (HNSCC). These studies provide strong evidence for improved survival outcomes in patients with HPV-positive HNSCC compared to those with HPV-negative HNSCC. In many reports, HPV status is the strongest predictor of locoregional control, disease specific survival and overall survival. In response to these findings, there has been significant interest in the best management of HPV-positive disease. Discussions within major cooperative groups consider new trials designed to maintain the current strong survival outcomes while reducing the long-term treatment-related toxicities. This review will highlight the epidemiological, clinical and molecular discoveries surrounding HPV-related HNSCC over the recent decades and we conclude by suggesting how these findings may guide future treatment approaches.
Core tip: Head and neck squamous cell carcinoma (HNSCC) is the fifth most common cancer, and historically, in the developed world, was associated with tobacco and alcohol. However, beginning in 1983, investigators have found a growing proportion of HNSCC patients with human papillomavirus-positive (HPV) tumors who neither drank nor used tobacco. HPV has shifted the epidemiology and prognosis of HNSCC and HPV status is the strongest positive prognostic marker in patients with oropharyngeal SCC. This review will highlight the epidemiological, clinical and molecular discoveries surrounding HPV-related HNSCC over the recent decades and how these findings will guide future treatment approaches.