Oropharyngeal cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Sodium thiosulfate

As cisplatin is still the standard option for chemotherapy, patients with oropharyngeal cancer are at risk of hearing loss. However, new agents are being investigated to reduce cisplatin-induced ototoxicity. Sodium thiosulfate has been reported to decrease the risk of ototoxicity in children with hepatoblastoma.[107] Prospective studies are needed to compare agents with minimal ototoxicity, such as immunotherapy, to cisplatin-based regimens.

Panitumumab

An antiepidermal growth factor receptor monoclonal antibody, panitumumab, has been reported to improve progression-free survival in recurrent or metastatic head and neck cancer patients when added to chemotherapy.[108] The addition of panitumumab did not improve survival in patients with locally advanced oropharyngeal cancer. In the metastatic setting, the combination of chemotherapy and panitumumab may improve disease-free survival and should be investigated in future prospective trials.

Biomarkers

The presence of oncoprotein E6 may confer a survival advantage for human papillomavirus (HPV)-16-induced oropharyngeal cancer because of the enhanced rate of apoptosis observed with radiation.[109] Increased expression of epidermal growth factor receptor (EGFR) in the tumor specimen may confer a poor prognosis highlighting the importance of biomarkers in future prospective trials.[110] It is possible that the traditional treatment algorithm may change in the future when taking into consideration the absence or presence of these biomarkers. In HPV-associated oropharyngeal cancer, cell-free HPV DNA (ctDNA) has emerged as a potential surveillance biomarker. It has very high sensitivity and specificity in the detection of early recurrence and minimal residual disease. In some cases, it can detect recurrence up to months ahead of radiographic signs of recurrence on PET/CT. Ongoing studies will determine its impact on surveillance guidelines and intervals.

Tomotherapy-based image-guided radiation therapy (IGRT)

IGRT is a special type of intensity-modulated radiation therapy (IMRT) that may be a promising new technique for delivering radiation therapy because it decreases the radiation dose to normal tissues.[111] Further investigations are required.

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