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The global rise of oropharyngeal cancers (OPC) associated with the human papillomavirus (HPV) type 16 necessitates a deeper understanding of their underlying molecular mechanisms. Our study utilised RNA-sequencing data from The Cancer Genome Atlas (TCGA) to identify and analyse differentially expressed (DE) long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and messenger RNAs (mRNAs) in HPV16-positive OPC, and to elucidate the interplay within the lncRNA/miRNA/mRNA regulatory network. We revealed 1929 DE lncRNAs and identified a significant expression shift in 37 of these, suggesting a regulatory 'sponge' function for miRNAs that modulate cellular processes. Notably, the lncRNA Linc00911 exhibited decreased expression in HPV16-positive OPC, a change directly attributable to HPV oncogenes E6 and E7 as confirmed by RT-qPCR in cell lines and patient samples. Our comprehensive analysis presents an expansive landscape of ncRNA-mRNA interactions, offering a resource for the ongoing pursuit of elucidating the molecular underpinnings of HPV-driven OPC.
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BACKGROUND: To investigate the technical feasibility of RT-PCR and direct sequencing to quantify HPV DNA in the saliva of patients with Human-Papilloma-Virus related oropharyngeal cancer (HPV-OPC), the level of which is known to predict prognosis after treatment. METHODS: Nine patients with locally advanced HPV-OPC treated with definitive radiotherapy with chemotherapy or cetuximab, or radiotherapy alone between April 2016 and September 2017, were enrolled, two of whom also received induction chemotherapy. Saliva was collected before (baseline), during (mid-RT) and after (post-RT) radiotherapy. HPV-16 DNAs (E6 and E7) in saliva were quantified by RT-PCR and sequencing, the latter using a custom cancer panel. Correlations between HPV DNA levels and clinical outcomes were assessed. RESULTS: Compared to the baseline, the relative cycle threshold (Ct) value of E6 and E7 reduced at the point of mid-RT in the majority of the patients (100% and 75% for E6 and E7, respectively). Similarly, the relative Ct value from the baseline to post-RT reduced in 86% and 100% of the patients for E6 and E7, respectively. During the follow-up period, three patients (33%) experienced disease progression. The relative baseline Ct values of these three patients were in the top 4 of all the patients. The sequences of HPV DNA were detected in five (83%) of six samples of the baseline saliva that underwent DNA sequencing, along with several gene mutations, such as TP53,CDKN2A and PIK3CA. CONCLUSIONS: This study demonstrates that, in addition to detection and quantification of HPV DNA by RT-PCR, detection by sequencing of HPV-DNA using a customized cancer panel is technically possible.
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ADN Viral , Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Saliva , Humanos , Neoplasias Orofaríngeas/virología , Neoplasias Orofaríngeas/radioterapia , Saliva/virología , ADN Viral/análisis , Persona de Mediana Edad , Masculino , Femenino , Anciano , Infecciones por Papillomavirus/virología , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/aislamiento & purificaciónRESUMEN
OBJECTIVE: Patients treated for oropharyngeal cancer (OPC) have historically demonstrated high feeding tube rates for decreased oral intake and malnutrition. We re-examined feeding tube practices in these patients. STUDY DESIGN: Retrospective analysis of prospective cohort from 2015 to 2021. SETTING: Single-institution NCI-Designated Comprehensive Cancer Center. METHODS: With IRB approval, patients with new oropharyngeal squamous cell cancer or (unknown primary with neck metastasis) were enrolled. Baseline swallowing was assessed via videofluoroscopy and Performance Status Scale for Head and Neck Cancer (PSSHN). G-tubes or nasogastric tubes (NGT) were placed for weight loss before, during, or after treatment. Prophylactic NGT were placed during transoral robotic surgery (TORS). Tube duration was censored at last disease-free follow-up. Multivariate regression was performed for G-tube placement (odds ratio [OR] [95% confidence interval [CI]) and removal (Cox hazard ratio, hazard ratio [HR] [95% CI]). RESULTS: Of 924 patients, most had stage I to II (81%), p16+ (89%), node-positive (88%) disease. Median follow-up was 2.6 years (interquartile range 1.5-3.9). Most (91%) received radiation/chemoradiation, and 16% received TORS. G-tube rate was 27% (5% after TORS). G-tube risk was increased with chemoradiation (OR 2.78 [1.87-4.22]) and decreased with TORS (OR 0.31 [0.15-0.57]) and PSSHN-Diet score ≥60 (OR 0.26 [0.15-0.45]). G-tube removal probability over time was lower for T3 to T4 tumors (HR 0.52 [0.38-0.71]) and higher for PSSHN-Diet score ≥60 (HR 1.65 [1.03-2.66]). CONCLUSIONS: In this modern cohort of patients treated for OPC, 27% received G-tubes-50% less than institutional rates 10 years ago. Patients with preserved baseline swallowing and/or those eligible for TORS may have lower G-tube risk and duration.
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Nutrición Enteral , Intubación Gastrointestinal , Neoplasias Orofaríngeas , Sistema de Registros , Humanos , Neoplasias Orofaríngeas/terapia , Neoplasias Orofaríngeas/patología , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Estudios Prospectivos , Procedimientos Quirúrgicos RobotizadosRESUMEN
Oropharyngeal cancer (OPC) comprises a group of various malignant tumours that grow in the throat, larynx, mouth, sinuses, and nose. THE RESEARCH AIMS: to investigate the performance of the OPC VMAT model by comparison to clinical plans in terms of dosimetric parameters and normal tissue complication probabilities. PURPOSE: Tune the model which at least matches the performance of clinical created photon treatment plans and analyse and find the most appropriate strategic plan scheme for OPC. METHODS AND MATERIALS: The machine learning (ML) plans are compared to the reference plans (clinical plans) based on dose constraints and target coverage. VMAT oropharynx ML model of Raystation development 11B version (non-clinical) was used. A model was trained by using different modalities. A different strategy of machine learning and clinical plans was performed for five patients. The dose Prescribed for OPC is 70 Gy, 2 Gy per fraction (2Gy/Fx). The PTV was derived for the primary tumour and secondary tumour, PTV+7000 cGy and PTV_5425 cGy volumetric modulated arc therapy (VMAT) were used with beams performing a full 360° rotation around the single isocenter. RESULTS: Organs at risk were observed that the volume of L-Eye in clinical plan (AF) for the case1 treatment planning could be successfully used ensuring efficiency and lower than MLVMAT and MLVMAT-org plans were 372 cGy, 697 cGy and 667 cGy respectively, while showed case2, case3, case4 and case5 are better to protect the critical organs in ML plan compare with a clinical plan. DHI for the PTV-7000 and PTV-5425 is between 1 and 1.34, While DCI for PTV-7000 and PTV-5425 is between 0.98 and 1.
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Neoplasias Orofaríngeas , Radioterapia de Intensidad Modulada , Humanos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia de Intensidad Modulada/métodos , Neoplasias Orofaríngeas/diagnóstico por imagen , Neoplasias Orofaríngeas/radioterapiaRESUMEN
BACKGROUND: Human papillomavirus (HPV)-related oropharyngeal cancer screening is being explored in research studies, but strategies to identify an appropriate population are not established. The authors evaluated whether a screening population could be enriched for participants with oncogenic HPV biomarkers using risk factors for oral HPV. METHODS: Participants were enrolled at Johns Hopkins Hospitals and Mount Sinai Icahn School of Medicine. Eligible participants were either men aged 30 years or older who had two or more lifetime oral sex partners and a personal history of anogenital dysplasia/cancer or partners of patients who had HPV-related cancer. Oral rinse and serum samples were tested for oncogenic HPV DNA, RNA, and E6 or E7 antibodies, respectively. Participants with any biomarker were considered at-risk. RESULTS: Of 1108 individuals, 7.3% had any oncogenic oral HPV DNA, and 22.9% had serum antibodies for oncogenic HPV E6 or E7. Seventeen participants (1.5%) had both oral and blood biomarkers. HPV type 16 (HPV16) biomarkers were rarer, detected in 3.7% of participants, including 20 with oral HPV16 DNA and 22 with HPV16 E6 serum antibodies (n = 1 had both). In adjusted analysis, living with HIV (adjusted odds ratio, 2.65; 95% CI, 1.60-4.40) and older age (66-86 vs. 24-45 years; adjusted odds ratio, 1.70; 95% CI, 1.07-2.70) were significant predictors of being at risk. Compared with the general population, the prevalence of oral HPV16 (1.8% vs. 0.9%), any oncogenic oral HPV DNA (7.3% vs. 3.5%), and HPV16 E6 antibodies (2.2% vs. 0.3%) was significantly elevated. CONCLUSIONS: Enrichment by the eligibility criteria successfully identified a population with higher biomarker prevalence, including HPV16 biomarkers, that may be considered for screening trials. Most in this group are still expected to have a low risk of oropharyngeal cancer.
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Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Masculino , Humanos , Virus del Papiloma Humano , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Prevalencia , Boca , Papillomavirus Humano 16/genética , Biomarcadores , Factores de RiesgoRESUMEN
Background: The morbidity of oropharyngeal cancer (OPC) is continuing to rise in numerous developed countries. An accurate prognostic assessment is needed to evaluate the malignant degree or risk classification to optimize treatment. Albumin (ALB) as an independent prognostic indicator of cancer survival has been established in previous studies. This study investigated the prognostic value of pre-treatment serum ALB in OPC patients. Methods: The clinicopathological data of 246 patients diagnosed with OPC from 2010 to 2019 were analyzed retrospectively. Analyze the relationship between ALB and clinicopathological characteristics of patients. The optimal cut-off values for ALB were determined via Cutoff Finder (Method for cutoff determination: Survival: significance (log-rank test)). To determine the independent prognostic factors, the Cox proportional hazards model was used to perform univariate and multivariate analyses of the serum ALB levels related to overall survival (OS) and disease-free survival (DFS). Results: The optimal cut-off point for ALB was 39.15 g/L determined via Cutoff Finder. Serum ALB levels were significantly associated with age (P=0.047), Presence of comorbidity (P=0.009), Charlson score index (P=0.007), Hemoglobin (P<0.001), Neutrophil to Lymphocyte Ratio (P=0.002), Albumin-To-Alkaline Phosphatase Ratio (P<0.001), Alkaline phosphatase (P=0.005), T stage (P=0.016), and HPV status (P=0.002). In the univariate and multivariate analyses, ALB was found to be an independent prognostic indicator for DFS (HR =0.39, 95% CI:0.23-0.66, P=0.000) and OS (HR =0.46, 95% CI: 0.25-0.83, P=0.01) in OPC patients. Conclusions: Pre-treatment serum ALB could serve as a valuable prognostic biomarker for the prognostic stratification of OPC patients.
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Objectives: Public understanding of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is minimally understood. Therefore uncovering communication gaps between the public and healthcare professionals regarding this disease is vital. Social media provide an unobtrusive way to understand public perception about health issues. Study design: Computer-assisted quantitative content analysis. Methods: Tweets about HPV-associated OPC (N = 3,112) were collected for 40 weeks using the standard real-time streaming Application Programming Interface (API). The collection of tweets was not limited to one specific geographic location but worldwide. All tweets were entered into nVivo 12.0 to conduct computer-assisted quantitative content analysis. We used an inductive method to develop a coding scheme and examined the frequency of specific keywords, terms, and phrases in texts. Results: Findings show that (a) the majority of discourse on Twitter focused on risk factors and prevention with little information on diagnosis, treatment, and prognoses; (b) many tweets promoted HPV vaccination among boys and emphasized the risk of HPV-associated OPC among males; (c) the role of dental care professionals in the prevention and detection of OPC minimally appeared; (d) the public referred to OPC as oral cancer, head and neck cancer, or throat cancer; and (e) health organizations in New Zealand, Australia, and the United Kingdom led the discussion on HPV-associated OPC on Twitter. Conclusions: The current study unravels the utility of social media data and data mining techniques in understanding public perception and understanding of HPC-associated OPC. The outcomes from the current study provide baseline knowledge of where communication gaps exist in terms of HPV-associated OPC, without which the planning of potential interventions and much-needed social media-based campaigns cannot be effectively undertaken.
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OBJECTIVE: The objective was to perform risk stratification of oropharyngeal cancer (OPC) for treatment de-escalation based on the radiomics analysis and human papillomavirus (HPV) status. METHODS: A total of 265 patients with OPC who underwent baseline contrast-enhanced computed tomography were analyzed, and the patients were grouped into the training (n = 133) and test (n = 132) cohorts at a ratio of 1:1. Intratumoral and peritumoral radiomics features were extracted, and the radiomics signature (Rscore) was calculated using least absolute shrinkage and selection operator regression (LASSO) and Cox regression analyses. RESULTS: Twelve features were selected to establish the radiomics signature (Rscore) of intratumoral regions +10-mm peritumoral regions, which yielded maximum AUCs of 0.835, 0.798, and 0.784 in the training, test, and validation cohorts, respectively. Patients with OPC were divided into the high-risk group, intermediate-risk group, and low-risk group based on the Rscore and HPV status and had different prognoses. Patients in the low-risk group benefit from radiotherapy alone, and patients in the intermediate-risk group only benefitted from chemoradiotherapy. CONCLUSION: The radiomics signature appears to improve the predictive performance of clinical characteristics for oropharyngeal cancer. The combined stratification of the radiomics signature and HPV status might be preferred to select patients for de-escalated treatment.
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Oropharyngeal cancer (OPC), which is a common type of head and neck squamous cell carcinoma (HNSCC), is associated with tobacco and alcohol use, and human papillomavirus (HPV) infection. Underlying mechanisms and as a result prognosis of the HPV-positive and HPV-negative OPC patients are different. Like stem cells, the ability of self-renewal and differentiate, cancer stem cells (CSCs) have roles in tumor invasion, metastasis, drug resistance, and recurrence after therapy. Research revealed their roles to some extent in all of these processes but there are still many unresolved points to connect to CSC-targeted therapy. In this review, we will focus on what we currently know about CSCs of OPC and limitations of our current knowledge. We will present perspectives that will broaden our understanding and recent literature which may connect to therapy.
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Human papillomavirus (HPV)-positive oropharyngeal cancers (OPC) are increasing due to infection with the virus. Most of the patients diagnosed with HPV-positive OPC are white men with numerous lifetime sexual partners who have smoked marijuana excessively. In working up the patient, it is important to obtain an extensive history and physical examination and obtain proper imaging. Once a full workup is done, it is crucial to engage a multidisciplinary team in treatment and continue following-up with the patient through posttreatment surveillance. Administering the HPV vaccine at a young age may help reduce the increasing rate of HPV-positive OPC in the future.
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Neoplasias de Cabeza y Cuello/patología , Infecciones por Papillomavirus/patología , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/virología , Humanos , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/virología , Papillomaviridae , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/terapia , Vacunas contra Papillomavirus/administración & dosificación , Atención Primaria de Salud , Infecciones del Sistema Respiratorio/patología , Factores de RiesgoRESUMEN
More than a decade after the discovery of p16 immunohistochemistry (IHC) as a surrogate for human papilloma virus (HPV)-driven head and neck squamous cell carcinoma (HNSCC), p16-IHC has become a routinely evaluated biomarker to stratify oropharyngeal squamous cell carcinoma (OPSCC) into a molecularly distinct subtype with favorable clinical prognosis. Clinical trials of treatment de-escalation frequently use combinations of biomarkers (p16-IHC, HPV-RNA in situ hybridization, and amplification of HPV-DNA by PCR) to further improve molecular stratification. Implementation of these methods into clinical routine may be limited in the case of RNA by the low RNA quality of formalin-fixed paraffin-embedded tissue blocks (FFPE) or in the case of DNA by cross contamination with HPV-DNA and false PCR amplification errors. Advanced technological developments such as investigation of tumor mutational landscape (NGS), liquid-biopsies (LBx and cell-free cfDNA), and other blood-based HPV immunity surrogates (antibodies in serum) may provide novel venues to further improve diagnostic uncertainties. Moreover, the value of HPV/p16-IHC outside the oropharynx in HNSCC patients needs to be clarified. With regards to therapy, postoperative (adjuvant) or definitive (primary) radiochemotherapy constitutes cornerstones for curative treatment of HNSCC. Side effects of chemotherapy such as bone-marrow suppression could lead to radiotherapy interruption and may compromise the therapy outcome. Therefore, reduction of chemotherapy or its replacement with targeted anticancer agents holds the promise to further optimize the toxicity profile of systemic treatment. Modern radiotherapy gradually adapts the dose. Higher doses are administered to the visible tumor bulk and positive lymph nodes, while a lower dose is prescribed to locoregional volumes empirically suspected to be invaded by tumor cells. Further attempts for radiotherapy de-escalation may improve acute toxicities, for example, the rates for dysphagia and feeding tube requirement, or ameliorate late toxicities like tissue scars (fibrosis) or dry mouth. The main objective of current de-intensification trials is therefore to reduce acute and/or late treatment-associated toxicity while preserving the favorable clinical outcomes. Deep molecular characterization of HPV-driven HNSCC and radiotherapy interactions with the tumor immune microenvironment may be instructive for the development of next-generation de-escalation strategies.
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BACKGROUND: Oropharyngeal cancer (OPC) is a type of head and neck squamous cell cancer, the incidence of which has increased in recent years. Many studies have reported a variety of prognostic markers of OPC, but they are either expensive or difficult to obtain. Therefore, we retrospectively studied the prognostic value of circulating neutrophil count (CNC) in patients with OPC, with the aim of providing a theoretical basis for further prognostic stratification. METHODS: The clinicopathological data of 153 patients diagnosed with OPC from January 2010 to June 2017 were retrospectively analyzed. The CNC of each patient was measured before treatment. Then, the relationship between CNC and the clinicopathological characteristics of the patients was analyzed. The receiver operating characteristic (ROC) curve was used to calculate the cutoff value of CNC. The cox proportional hazards model was used to perform univariate and multivariate analysis of the relevant prognostic factors to determine the factors related to overall survival (OS) and progression-free survival (PFS). RESULTS: The cutoff value for CNC was 4.48. Neutrophilia was significantly associated with disease stage, P16 status, and the type of therapy. In the univariate and multivariate analyses, CNC was found to be correlated with OS and PFS. Increased neutrophil count was predictive of poor OS (P<0.001) and PFS (P=0.001). Neutrophil count was an independent risk factor for OS (HR =2.09, 95% CI: 1.25-3.51, P=0.005) and PFS (HR =1.78, 95% CI: 1.10-2.88, P=0.02) in patients with OPC. CONCLUSIONS: Pre-treatment CNC is an independent prognostic factor for OPC.
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This study aims to evaluate the effectiveness of an educational intervention that was designed to increase human papillomavirus (HPV) awareness and knowledge among oral health providers (OHPs). HPV educational lectures and a dental information toolkit on HPV were offered to OHPs in New England in 2016-2017. OHPs included dentists and dental hygienists. Post intervention surveys were distributed 1 month later. A total of 230 participants attended the educational lectures and received the toolkit. Descriptive statistics were used to compare the difference in knowledge and preparedness about HPV before and after the intervention. Eighty-nine OHPs completed the surveys. The response rate was 38.7%; however, for each question, the number of responses varied. Fifty-four (54%) (n = 26) of survey respondents were between 55 and 75 years of age with 73.5% (n = 36) being female and 55% (n = 45) working in private practice. Post intervention, 67.5% (n = 27) of the respondents felt more prepared, 82.6% (n = 38) reported clarity of their roles in educating their patients about HPV, and 91.6% (n = 44) reported an increase in knowledge about HPV. The HPV educational intervention was well received and successful at improving self-reported knowledge, comfort level, and preparedness of OHPs in discussing HPV with their patients. OHPs have the great opportunity to educate their patients about HPV and HPV vaccination. Further continuing education efforts may improve OHPs' participation in HPV prevention.
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Actitud del Personal de Salud , Odontólogos/educación , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Salud Bucal/educación , Infecciones por Papillomavirus/prevención & control , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , New England/epidemiología , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Vacunas contra Papillomavirus/administración & dosificación , Encuestas y Cuestionarios , Vacunación , Adulto JovenRESUMEN
BACKGROUND: Patients with human papillomavirus (HPV)-related oropharyngeal cancers (OPCs) have superior outcomes in comparison with patients with non-HPV-induced OPCs. This study confirms that a previously proposed HPV risk-adapted restaging system better reflects disease outcomes. METHODS: The National Cancer Data Base was used to analyze 8803 HPV+ OPC patients. Univariate and multivariate analyses were performed to identify the utility of both American Joint Commission on Cancer (AJCC) staging and HPV risk-adapted staging in predicting the outcomes of patients with HPV+ OPC and other factors influencing survival. RESULTS: With a median follow-up of 27.1 months, 3.2% had AJCC stage I disease and 6.6%, 19.4%, and 70.9% had stage II, III, and IV disease, respectively. When the patients were restaged according to HPV risk-adapted staging, 76.6% had stage I disease, 9.9% had stage II disease, and 13.5% had stage III disease. The 4-year overall survival rates according to HPV risk-adapted staging were 85.8%, 77.3%, and 64.6% for stages I, II, and III, respectively, but the rates for AJCC stages I, II, III, and IV were 90.1%, 86.1%, 87.0%, and 80.1%, respectively. Patients with HPV+ metastatic disease at diagnosis had a significantly improved median survival of 20.5 months versus 11.1 months with HPV- disease (P < .01). In the multivariate analysis, survival was also affected by the age at treatment, a nontonsillar or base-of-tongue primary site, private insurance, an annual income ≥ $48,000/y, and the comorbidity index (all P values < .01). CONCLUSIONS: Outcomes of HPV+ OPC are significantly improved in comparison with HPV- OPC outcomes, and the current AJCC staging system does not accurately reflect disease outcomes. This study has retrospectively confirmed that an HPV risk-adapted restaging structure more accurately stratifies patients. Under this new risk-stratified staging system, patients may be more accurately stratified for investigation into treatment escalation or de-escalation studies. Cancer 2016;122:2021-30. © 2016 American Cancer Society.
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Estadificación de Neoplasias/métodos , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/complicaciones , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/patología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
AIM OF THE STUDY: Radiotherapy (RT) is a radical therapeutic option for patients with oropharyngeal cancer (OPC). It induces an acute postradiation reaction that may cause significant pain. The aim of this study was to analyse pain occurrence and intensity, as well as type and effectiveness of analgesic treatment, in OPC patients undergoing RT or radiochemotherapy (RT-CT). MATERIAL AND METHODS: Retrospective data were obtained for 42 OPC patients at clinical stages I-IVA, treated with adjuvant RT or RT-CT or definite RT or RT-CcT at the Comprehensive Cancer Center in Bialystok, Poland. Pain intensity and type of analgesic treatment during the therapy were analysed and compared with the intensity of the radiation-induced acute reaction, assessed weekly according to the Dische score. RESULTS: Thirty-nine (92.9%) patients received analgesic treatment. Analgesic therapy was started in 27 (64.3%) patients with administration of non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol, in seven (16.7%) with mild opioids and in five (11.9%) with strong opioids. Strong opioids were used during therapy in 21 (50%) patients. Co-analgesics were administered to six patients. Breakthrough pain was observed in 10 (23.8%) patients. CONCLUSIONS: High incidence of pain during RT and RT-CT calls for increased awareness of the importance of pain monitoring and treatment during RT of OPC patients. The analgesic treatment had to be adjusted individually.
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Neoplasias Orofaríngeas/radioterapia , Manejo del Dolor/métodos , Acetaminofén/uso terapéutico , Adulto , Anciano , Analgésicos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Antineoplásicos/uso terapéutico , Quimioradioterapia/métodos , Quimioradioterapia Adyuvante , Cisplatino/uso terapéutico , Dipirona/uso terapéutico , Combinación de Medicamentos , Femenino , Fentanilo/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Estadificación de Neoplasias , Neoplasias Orofaríngeas/terapia , Dolor/clasificación , Radioterapia Adyuvante , Radioterapia de Alta Energía/métodos , Estudios Retrospectivos , Tramadol/uso terapéuticoRESUMEN
The incidence of oropharyngeal carcinoma is increasing in many countries of the developed world, largely because of cancers caused by infection with human papillomavirus (HPV). HPV-positive patients may ask questions that fall outside the remit of traditional consultations held in head and neck clinics. The purpose of this article is to highlight key messages about HPV and oropharyngeal cancer that are relevant to patients. Key messages include: HPV is a very common virus that transiently infects most people at some point in their lives; HPV infection is transmitted by normal sexual activity and is not a marker of promiscuity or abnormal sexual practices; HPV infections may be acquired many years before a cancer develops and infection does not imply recent infidelity; long-term partners of HPV-positive patients do not seem to be at increased risk of HPV infection.