HPV-related squamous cell cancers are an increasingly common cause of malignancy in the oropharynx. There is evidence that these cancers are associated with a significantly improved overall survival compared to conventional HPV-negative tumours. The optimal treatment for such cancers is uncertain and deintensification therapeutic regimes are the subject of ongoing research. Some studies have shown that single modality treatment, including transoral robotic surgery (TORS), may be sufficient. It has also been suggested that surgical management may allow better patient risk stratification than radiotherapy, through evaluation of established risk factors such as extracapsular spread (ECS), and guide selection of adjuvant therapy in high-risk patients. This study, from a leading TORS centre, examined 114 patients with HPV-positive oropharyngeal cancer treated with an initial TORS resection (although many of the patients went on to receive adjuvant radiotherapy +/- chemotherapy) and analysed factors associated with treatment failure. A two-year 3.3% locoregional and 8.4% distant failure rate was reported. None of the established risk-factors for treatment failure, such as ECS or margin status, were found to be significant. Further research is needed with larger sample sizes and a clearer distinction between the treatment modalities, to determine the optimal treatment of HPV-related oropharyngeal cancer. 

HPV-related oropharyngeal cancer: Risk factors for treatment failure in patients managed with primary transoral robotic surgery.
Kaczmar JM, Tan KS, Heitjan DF, et al.
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Jonathan Hughes

Locum Consultant, Oxford University Hospitals Trust, UK.

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