Treatment of P16-Negative/HPV-Negative Oropharyngeal Squamous Cell Carcinoma: A Survey of AHNS Membership.

Abstract

To investigate practice patterns in the treatment of p16-negative/human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC) among members of the American Head and Neck Society (AHNS). Cross-sectional. Online electronic survey. An online survey was distributed via AHNS survey system. Participation was voluntary, and data were anonymously collected. 108 members (7.7% of AHNS members) responded. Most (65.7%) had ≥5 years of experience in the field. Few practitioners (23.2% always and 10.2% frequently) confirmed HPV-negative status with DNA/RNA in situ hybridization or PCR testing for p16-negative tumors. Most surgeons (60.2%) reported recommending TORS for identification of an unknown primary in a patient with p16-/HPV-negative neck mass. Similarly, at least half (56.5%) of surgeons indicated always or frequently treating resectable T1-T3 with TORS. The majority (73.2%) of surgeons indicated infrequently (59.3%) or never (13.9%) treating T3/T4 with traditional open surgery as first line. More than half of the surgeons (57.4%) believed survival is better with surgery compared to definitive nonsurgical therapy for HPV-negative OPSCC. There was wide variation in the use of treatment intensification (dual modality adjuvant treatment for T1-2N0, or tri-modality treatment for T1-T2N1), with 19.4% reporting never, 36.1% infrequently, 34.3% frequently, and 10.2% always doing so. A majority of AHNS surgeons (57.4%) believe survival for HPV-negative OPSCC is better with surgery. Most (56.5%) would treat resectable T1-T3 tumors with TORS, while the minority (26.8%) would frequently or always operate on T3-T4 tumors. There was wide variation in practice with respect to treatment intensifiication owing to remaining knowledge gaps in the field.