Surveillance Imaging in HPV-related Oropharyngeal Cancer

Anticancer Res. 2018 Mar;38(3):1525-1529. doi: 10.21873/anticanres.12380.

Abstract

Background/aim: Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the method of recurrence detection in HPV+ disease to determine a role for follow-up imaging.

Patients and methods: All HPV+ and HPV- oropharyngeal cancer patients treated at our institution from 2005-2016 with biopsy-proven recurrence were identified and their method of recurrence detection was analyzed.

Results: A total of 16 HPV+ oropharyngeal cancer patients were identified to have recurrence, 12 (75%) of which experienced distant recurrence and 13 (81.3%) were detected asymptomatically with imaging at a median time of 19.7 months after initial treatment and verifying no residual disease. Twelve (75%) detections were with PET-CT. While HPV- patients (17 patients) also have a high rate of asymptomatic detection (16 patients, 94.1%), their 3-year post-recurrence survival was significantly lower at 6.5% compared to 83.6% for the HPV+ group (p<0.01).

Conclusion: In HPV+ patients, a large proportion of failures are asymptomatic distant metastases, which occur beyond 6 months following treatment completion, and are detected with whole body imaging alone. In light of long term post-recurrence survival observed, this preliminary data suggests that routine surveillance imaging should be further studied for HPV+ disease.

Keywords: CT; HPV; PET/CT; oropharyngeal cancer; recurrence detection; surveillance imaging.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Oropharyngeal Neoplasms / complications
  • Oropharyngeal Neoplasms / diagnostic imaging*
  • Oropharyngeal Neoplasms / therapy*
  • Papillomaviridae / physiology
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / virology
  • Positron Emission Tomography Computed Tomography / methods*
  • Retrospective Studies
  • Salvage Therapy / methods*
  • Treatment Outcome