New Staging System on Horizon for Head and Neck Cancers

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Take-Home Points

• A new staging system for head and neck cancers will go into effect in 2018 and will include sweeping changes in the classifications of mucosal melanoma, oropharyngeal cancer, cancer with an unknown primary, and cancer of the oral cavity.
• Robotic surgery continues to evolve.
• Some patients experience dramatic success with checkpoint inhibitor therapies, with complete eradication of cancer in the neck.

Further reading: Abstracts from The Laryngoscope

Recent Trends in Oropharyngeal Cancer Funding

Objectives/hypothesis: The incidence of oropharyngeal cancer (OPC) has increased in the United States. This has been driven by an increase in human papillomavirus (HPV)-positive OPC. Our objective is to determine trends in NIH-supported research funding and public interest in OPC.

Methods: The NIH Research Portfolio Online Reporting Tools database was evaluated for projects related to OPC between 2004 and 2015. Projects were evaluated for total funding, relation to HPV, principal investigator departmental affiliation and degree, and NIH agency or center responsible for grant. Google Trends was evaluated for relative Internet search popularity of oropharyngeal cancer and related search terms.

Results: In terms of NIH funding, 100 OPC-related projects representing 242 grant years and $108.5 million were funded between 2004 and 2015. Total NIH funding for OPC projects increased from $167,406 in 2004 to $16.2 million in 2015. Funding for HPV-related OPC increased from less than $2 million yearly between 2004 and 2010 up to $12.7 million in 2015. Principal investigators related to radiation oncology ($41.8 million) and with doctor of medicine degrees ($52.8 million) received the largest share of total funding. Relative Internet search popularity for oropharyngeal cancer has increased from 2004 to 2015 compared to control cancer search terms.

Conclusion: Increased public interest and NIH funding has paralleled the rising incidence of OPC. NIH funding has been driven by projects related to the role of HPV in OPC (Laryngoscope. 2017;127:1345–1350).

Impact of TORS on Overall Treatment of patients with Oropharyngeal Cancer

Objectives/hypothesis: To assess adjuvant therapy in patients undergoing surgical management of oropharyngeal squamous cell carcinoma (OPSCCA) with transoral robotic surgery (TORS) and neck dissection.

Methods: Patients undergoing treatment for OPSCCA were selected from a prospective protocol evaluating functional and oncologic outcomes following TORS with a comparator group of OPSCCA patients receiving definitive chemoradiotherapy (CRT) participating in a separate prospective protocol.

Results: Forty-two patients represented the TORS group and 38 the CRT group. Twenty (48%) of the TORS patients received surgery only, whereas nine (21%) underwent adjuvant radiotherapy and 13 (31%) adjuvant CRT. Adjuvant therapy patients had a higher overall T and N stage than the TORS-only group. Surgery resulted in stage changes in 18 (43%) patients, leading to alteration in therapy for nine (21%) patients. The 3-year overall survival (OS), disease-specific survival (DSS), and locoregional control was 74% versus 90%, 94% versus 94%, and 72% versus 91% for the TORS-alone versus TORS plus adjuvant therapy groups, respectively. Comparison with the CRT group revealed a survival benefit in the TORS group approaching significance, with a 3-year OS of 83% versus 57% and DSS of 94% versus 85%, respectively.