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Oct 09
2011
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Role of radiology in HPV positive oropharyngeal carcinoma-revisitedPosted by: Team Iradix on Oct 09, 2011 Tagged in: Untagged
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Role of radiology in HPV positive oropharyngeal carcinoma-revisited
By Iradix team, September 29, 2011
HPV DNA is identified in 70% of the cases of oropharyngeal Ca (OPC), with well-known causal association as per the literature 1. It has been well described that oral infection with HPV 16 increases the risk of OPC, 14 times than in the general population 2, 3. It is also very well-known now, that HPV positive cases of OPC show better response to treatment and even to organ preservation treatment with better survival rate compared to HPV negative cases of OPC 3-6. But, it is quite challenging to evaluate the HPV status of these cases.
Iradix team tried to follow the American Society of Head and Neck Radiology 2010 and American Society of Neuroradiology 2011 annual meetings to see the current radiologic literature on the matter. We were pleased to see an abstract7 by Dr. Ajaykumar C. Morani from University of Michigan, Ann Arbor, MI. Dr. Ajaykumar C. Morani studied pretreatment postcontrast neck CT scans of 49 patients (male = 37, female = 12; age range = 45-76 years) diagnosed with oropharyngeal malignancies.
Dr. Morani and his team, evaluated various lymph nodal parameters including presence of low attenuation foci and cystic foci in the metastatic lymph nodes, morphology of the smaller lymph nodes and matting of lymph nodes. Dr. Morani et al. found that majority (72%) of their cases of OPC with intranodal cystic changes were HPV +ve. They also suggested using an extended criteria [intranodal cystic focus in association with morphologically normal-appearing smaller(<1.5cm) lymph nodes], which was seen only in HPV +ve OPC cases in their study.
Their conclusion was that intranodal cystic changes seen on the pretreatment postcontrast CT neck of patients with oropharyngeal malignancies, have favorable association with HPV status of these cases. When we talked to Dr. Ajaykumar Morani, he admitted that their study is a smaller study with few patients, but at the same time he also said that favorable results in their initial study call for larger prospective studies on the topic. He was very positive that if the results are consistent in the larger studies, intranodal cystic changes and their proposed extended criteria can serve as one of the important radiologic signatures for assessing the HPV status of the cases with oropharyngeal malignancies, who can undergo organ preservation treatment. Thus, it can be one of the major breakthroughs in the management of OPC cases.
Imaging is already used in cases of OPC, for diagnosis as well as for follow up evaluation following treatment. We believe that radiology can play even more or bigger role in the management of HPV +ve OPC cases with current developments, till we see the total impact of recently introduced HPV vaccines.
References:
1. Mannarini L, Kratochvil V, Calabrese L, et al. Human papilloma virus (HPV) in head and neck region: Review of literature. Acta Otorhinolaryngol Ital 2009;29:119-26.
2. Fakhry C, Gillison ML. Clinical implications of human papillomavirus in head and neck cancers. J Clin Oncol 2006;24:2606-11.
3. Smeets SJ, van der Plas M, Schaaij-Visser TB, et al. Immortalization of oral keratinocytes by functional inactivation of the p53 and pRb pathways. Int J Cancer 2011;128:1596-605.
4. de Jong MC, Pramana J, Knegjens JL, et al. HPV and high-risk gene expression profiles predict response to chemoradiotherapy in head and neck cancer, independent of clinical factors. Radiother Oncol 2010;95:365-70.
5. Fakhry C, Westra WH, Li S, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 2008;100:261-9.
6. Huang K, Xia P, Chuang C, et al. Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: The university of california-san francisco experience. Cancer 2008;113:497-507.
7. http://www.abstractsonline.com/Plan/ViewAbstract.aspx?sKey=15232003-e9fd-40db-b2db-61878bcd55df&cKey=f4ec2f9b-2f6c-4ec0-9eb8-f329c0e8314a&mKey={856276E9-84A7-4E7F-B60C-6D64F2D77CEF}
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Role of radiology in HPV positive oropharyngeal carcinoma-revisited
2011-11-01 07:50:14
Prashant Bhatt
Reviewed by Prashant Bhatt November 01, 2011
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Reviewed by Prashant Bhatt November 01, 2011
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