摘要
Over the last decades the United Kingdom has seen a general increase in the incidence of head and neck squamous cell carcinoma (HNSCC). In addition to the classical risk factors of smoking and alcohol consumption there now appears that a viral aetiology is attributed to a significant proportion of HNSCC. A number of studies have indicated that human papillomavirus (HPV) infection is implicated with the subtype HPV 16 being found in many histopathological specimens. Further evidence suggests that HPV positive status is a prognostic factor related to a favourable outcome in head and neck cancers. This premise may have a significant impact on our approach to treating HNSCC. Patients belonging to stages I/II are traditionally treated with curative intent, single modality treatments that are either radiation or surgery alone. These treatment regimens are relatively aggressive and may lead to severe functional impairment. HPV patients may not require such an approach. This dissertation examines the current evidence which has given rise to these assertions, and explores the unresolved issues preventing HPV positive status becoming part of the management convention. The methodology involved a comprehensive literature review. The literature conclusions and limitations are discussed with reference to what is becoming accepted universally in this field and what remains to be elucidated. The different prognosis and treatment reaction to radiotherapy and chemotherapy by HPV positive tumours could be extrapolated to suggest that HPV status detection is required to plan treatment regimes. Indeed a separate subset of patients could potentially be categorised with an improvement in morbidity.
Over the last decades the United Kingdom has seen a general increase in the incidence of head and neck squamous cell carcinoma (HNSCC). In addition to the classical risk factors of smoking and alcohol consumption there now appears that a viral aetiology is attributed to a significant proportion of HNSCC. A number of studies have indicated that human papillomavirus (HPV) infection is implicated with the subtype HPV 16 being found in many histopathological specimens. Further evidence suggests that HPV positive status is a prognostic factor related to a favourable outcome in head and neck cancers. This premise may have a significant impact on our approach to treating HNSCC. Patients belonging to stages I/II are traditionally treated with curative intent, single modality treatments that are either radiation or surgery alone. These treatment regimens are relatively aggressive and may lead to severe functional impairment. HPV patients may not require such an approach. This dissertation examines the current evidence which has given rise to these assertions, and explores the unresolved issues preventing HPV positive status becoming part of the management convention. The methodology involved a comprehensive literature review. The literature conclusions and limitations are discussed with reference to what is becoming accepted universally in this field and what remains to be elucidated. The different prognosis and treatment reaction to radiotherapy and chemotherapy by HPV positive tumours could be extrapolated to suggest that HPV status detection is required to plan treatment regimes. Indeed a separate subset of patients could potentially be categorised with an improvement in morbidity.
