Clinically Significant Human Papilloma Virus in Squamous Cell Carcinoma of the Head and Neck in UK Practice

Aims: The association between squamous cell carcinoma of the head and neck (HNSCC) and infection with human papilloma viruses (HPV) has created considerable interest. Rates of primary oropharyngeal cancers have shown increasing incidence and declining age at presentation over the last decade, believed to relate to infection with oncogenic or high-risk subtypes of HPV (HR-HPV). HR-HPV-associated tumours have reportedly improved outcomes when compared with HPV-negative cancers. Within the UK, rates of HR-HPV in HNSCC have not yet been reported. Materials and methods: We analysed consecutive retrospective cases of oropharyngeal cancer presenting between 2004 and 2007. Results: Thirty-seven per cent of 83 oropharyngeal tumours stained positively for p16(INK4A), a marker of HPV infection (73% tonsillar cancers being p16 (INK4A) positive, 30% tongue and 43% floor of mouth tumours). HPV16 DNA was demonstrated in 75% p16 (INK4A) cases. Despite being more advanced with higher T-stage and nodal burden at presentation, HR-HPV-associated HNSCC showed significantly improved rates of disease-free and overall survival, in particular with improved rates of response to radical radiotherapy. Conclusion: HPV16 infection seems to be a clinically significant cause of oropharyngeal HNSCC in the UK and the collection of national data should be supported. (C) 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.