Medical treatments for throat cancer (oropharyngeal cancer) that is associated with human papillomavirus (HPV) infection

Recent studies suggest a connection between a virus (human papillomavirus) and throat cancer (oropharyngeal cancer) in some patients. This review has been conducted to assess potential new treatments that have emerged as a result of this information.

When diagnosed, throat cancers can be at an advanced stage and radiotherapy (which uses beams of radiation to kill cancer cells) or chemotherapy (drugs which kill cancer cells) are the most frequently used treatments. Both have side effects and may result in a decreased ability to talk, eat or drink. Newer therapies (biological) are now emerging that will help the immune system to fight cancer.

So far, high-quality evidence to assess these new treatment protocols is lacking, but may be available after 2014 as several ongoing studies are completed. Important outcomes to measure will be the likelihood of survival from the various treatments, as well as side effects and quality of life in the longer term. This review will be updated to include this new evidence as it becomes available.

This review is currently up to date to June 2013.

Authors' conclusions: 

There is currently insufficient high-quality evidence for, or against, de-escalation of treatment for human papillomavirus-associated oropharyngeal carcinoma. Future trials should be multicentre to ensure adequate power. Adverse events, morbidity associated with treatment, quality of life outcomes and cost analyses should be reported in a standard format to facilitate comparison with other studies.

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Background: 

Human papillomavirus-associated oropharyngeal squamous cell carcinomas are a distinct subgroup of tumours that may have a better prognosis than traditional tobacco/alcohol-related disease. Iatrogenic complications, associated with conventional practice, are estimated to cause mortality of approximately 2% and high morbidity. As a result, clinicians are actively investigating the de-escalation of treatment protocols for disease with a proven viral aetiology.

Objectives: 

To summarise the available evidence regarding de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal squamous cell carcinoma.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 25 June 2013.

Selection criteria: 

Randomised controlled trials investigating de-escalation treatment protocols for human papillomavirus-associated, locally advanced oropharyngeal carcinoma. Specific de-escalation categories were: 1) bioradiotherapy (experimental) versus chemoradiotherapy (control); 2) radiotherapy (experimental) versus chemoradiotherapy (control); and 3) low-dose (experimental) versus standard-dose radiotherapy (control). The outcomes of interest were overall and disease-specific survival, treatment-related morbidity, quality of life and cost.

Data collection and analysis: 

Three authors independently selected studies from the search results and extracted data. We planned to use the Cochrane 'Risk of bias' tool to assess study quality.

Main results: 

We did not identify any completed randomised controlled trials that could be included in the current version of this systematic review. We did, however, identify seven ongoing trials that will meet our inclusion criteria. These studies will report from 2014 onwards. We excluded 30 studies on methodological grounds (seven randomised trials with post hoc analysis by human papillomavirus status, 11 prospective trials and 12 ongoing studies).

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