COSM14: HPV Status and Prognosis for Oropharyngeal Cancers

Surgical precision is of utmost importance, Dr. Johns added. The digital AcuBlade scanning micromanipulator, used under general anesthesia, is his favorite tool because of its precision. He urged caution in using fiber-based CO2 lasers on superficial disease on the free vocal fold edge, because they will “inherently” have instability.

Dr. Johns advised monitoring patients with RRP for dysplasia. At Emory, physicians assessed 85 consecutive patients and found that dysplasia was present in 28% percent of them. All patients had either HPV 6 or 11, and none had HPV 16 or 18. “[Dysplasia] is fairly common, and it warrants periodic surveillance,” he said. “As we’re treating more and more of these awake, we often are not biopsying them.”

Advocacy

Dr. Chhetri said he hopes the panel’s presentations result in better patient care. “The main thing is to realize that HPV status makes a difference for prognosis in oropharyngeal cancer, and we should always make sure that’s part of the diagnostic algorithm,” he said. “Can we treat these patients differently to minimize treatment complications? That’s going to be important in the future.”

Advocating HPV vaccinations, he said, is an important endeavor for all otolaryngologists. “We ourselves haven’t really talked about it very much. I think now we need to go further and we really need to advocate to our pediatric and other medical colleagues, saying, ‘Hey, we encourage you to encourage all of your eligible patients to be vaccinated,’ because the truth is, vaccination is the most effective strategy to prevent HPV-related disease.”