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Review
. 2014 Mar 15;88(4):761-70.
doi: 10.1016/j.ijrobp.2013.08.029.

Review of the clinical and biologic aspects of human papillomavirus-positive squamous cell carcinomas of the head and neck

Grace C Blitzer  1 , Molly A Smith  1 , Stephen L Harris  2 , Randall J Kimple  3
Affiliations
Review

Review of the clinical and biologic aspects of human papillomavirus-positive squamous cell carcinomas of the head and neck

Grace C Blitzer et al. Int J Radiat Oncol Biol Phys. .

Abstract

Human papillomavirus (HPV), a known etiology of a subset of head-and-neck squamous cell carcinomas (HNCs), causes numerous alterations in normal cellular functions. This article reviews the biology, detection, and treatment of HPV-positive HNC. The role of HPV oncoproteins in tumor development, the natural history of HPV infection, and risk factors for and prevention of transmission of oral HPV are considered. Commonly used methods for detecting HPV infection, including limitations of these methods, are discussed to aid the practicing clinician in using these tests in their clinical practice. Clinical characteristics of HPV-positive HNC, including potential explanations for the improved outcomes seen in patients with HPV-positive HNC, are assessed. Ongoing clinical trials specific for patients with HPV-positive HNC are described, and areas in need of additional research are summarized. Until the results of ongoing trials are known, treatment of HPV-positive HNC should not differ in clinical practice from treatment of similar non-HPV related cancers.

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Figures

Figure 1
Figure 1
The HPV genome is a double-stranded circular DNA containing approximately 8000 base pairs and encoding eight proteins (A). E6 (B) and E7 (C) are the predominant HPV oncogenes and target a variety of diverse cellular processes.
Figure 2
Figure 2
The only clinically used test that detects HPV DNA, in situ hybridization (ISH), utilizes oligonucleotide probes specific for the DNA of several high-risk HPV types (A, 40X magnification). Also shown is a slide stained as negative control for ISH (B). Immunohistochemistry for p16 (A, 4X magnification & B, 40X magnification) is another commonly accepted test to assess for HPV status with p16-positive tumors being deemed HPV-positive.
Figure 3
Figure 3
Potential factors contributing to improved outcomes in patients with HPV-positive HNC include the presence of viral-specific anti-tumor immunity, wild-type p53, HPV oncogene modulated genomic instability, and alterations in tumor microenvironment leading to improved tumor oxygenation.
See this image and copyright information in PMC

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