From the Guidelines
The management of HPV-related throat lesions primarily involves a multidisciplinary approach with surveillance, surgical intervention, and radiation therapy as needed, with a focus on preserving throat function and quality of life, as recommended by the most recent guidelines 1. The approach to managing HPV-related throat lesions can vary depending on the severity and stage of the disease.
- For low-grade lesions, watchful waiting with regular endoscopic examinations every 3-6 months may be appropriate, allowing for close monitoring of the lesion's progression.
- When intervention is necessary, surgical excision is often the first-line treatment, which can be performed using transoral robotic surgery (TORS) or transoral laser microsurgery (TLM) to preserve throat function, as supported by recent studies 1.
- For more advanced cases, a combination of surgery followed by adjuvant radiation therapy (typically 60-70 Gy over 6-7 weeks) may be recommended, with the goal of achieving optimal outcomes while minimizing treatment-related morbidity.
- In cases where surgery isn't feasible, definitive chemoradiation with cisplatin (100 mg/m² every 3 weeks during radiation) is the standard approach, as outlined in recent guidelines 1.
- HPV-positive oropharyngeal cancers generally have better prognosis than HPV-negative tumors, which may allow for de-escalation of treatment intensity in selected patients, although this approach requires careful consideration of individual patient factors and ongoing research 1.
- Post-treatment, patients require long-term surveillance with regular physical examinations and imaging studies for at least 5 years, to monitor for potential recurrence or late effects of treatment.
- The HPV vaccine (Gardasil 9) is recommended as a preventive measure for those who haven't been exposed to the virus, ideally before sexual debut, although it does not treat existing infections, as noted in earlier studies 1.
From the Research
Management Approach for HPV Lesions in the Throat
The management approach for human papillomavirus (HPV) lesions in the throat involves various treatment options, including:
- Local intratumor injections of cidofovir (CDV) for immunocompetent patients with hypopharyngeal/esophageal papillomatous lesions, as shown in a study from 2
- Neoadjuvant chemotherapy followed by risk/response-stratified de-escalation with transoral robotic surgery, de-escalated (chemo)radiation, or standard chemoradiation, as described in a study from 3
- Vaccination as the primary method of prevention, with the nonavalent HPV vaccine effective in preventing high-grade precancerous cervical lesions in noninfected patients, as stated in a study from 4
Diagnostic Approaches
Diagnostic approaches for HPV lesions in the throat include:
- HPV testing as part of the workup for patients with oropharyngeal carcinoma (OPC), as recommended by the international head and neck oncology community, according to a study from 5
- Circulating tumor HPV-DNA (ctHPV-DNA) measurement using HPV-SEQ in plasma, which can predict treatment response and surveil for disease recurrence, as shown in a study from 3
Treatment Outcomes
Treatment outcomes for HPV lesions in the throat can vary depending on the treatment approach and patient factors, such as:
- Survival outcomes comparable between weekly chemotherapy with radiation and high-dose cisplatin with radiation as organ preservation for patients with HPV-positive and HPV-negative locally advanced squamous cell carcinoma of the oropharynx, as described in a study from 6
- Rapid early clearance of ctHPV-DNA during neoadjuvant therapy predicting radiographic deep response, as shown in a study from 3