Van Abel, Kathryn

We sought to determine the incidence and location of human papillomavirus (HPV)–associated anogenital disease in women with HPV‐positive oropharyngeal squamous cell carcinoma (OPSCC) via a retrospective cohort study with prospective contact to update history at Mayo Clinic in Rochester, Minnesota. Females undergoing treatment for nonmetastatic HPV‐positive OPSCC from 2011 to 2019 were identified. Clinical history and outcomes were abstracted from medical records. Patients without documented anogenital history were contacted, consented, and administered a survey, and external records were requested and reviewed. Seventeen of 46 patients (37.0%) had a history of anogenital HPV‐associated disease, and 16 of 17 (94.1%) required procedures to diagnose or treat HPV lesions. The cervix was the most common site (16/17, 94.1%). Procedures included colposcopy (n = 6), cervical excision (n = 3), cryotherapy (n = 4), and hysterectomy (n = 3). One case of fatal cervical carcinoma was noted, diagnosed 1 year following OPSCC. Three of 17 (17.6%) had HPV‐related vulvovaginal disease, and 1 of 17 had anal disease. Patients with a history of HPV‐positive OPSCC may be at elevated risk for HPV‐associated anogenital disease.

ObjectiveTo describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC).Study DesignCase series with chart review.SettingTertiary care referral center.Subjects and MethodsA total of 286 patients with HPV‐positive OPSCC who underwent transoral robotic surgery–based treatment from May 2007 to May 2015.ResultsOf 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4‐1.0) and 1.8 years (IQR, 1.0‐2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow‐up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4‐3.8; range, 7 days–6.2 years). Estimated cancer‐specific survival rates at 3 years following intent‐to‐cure treatment were 63% (95% CI, 39‐100; number still at risk, 5) in the LRR group and 100% (95% CI, 100‐100; number still at risk, 2) in the DM group.ConclusionOverall, LRR and DM for HPV‐positive OPSCC following transoral robotic surgery–based therapy are infrequent. In our subset of patients who underwent intent‐to‐cure treatment, cancer‐specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV‐positive OPSCC should be recommended for appropriate candidates.