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Updated: Jan 9, 2026
Chromogenic In Situ Hybridization as a Tool for HPV-Related Head and Neck Cancer Diagnosis
Published on: June 14, 2019
Minimizing Chemoradiation Using a Surgical Algorithm for HPV-Associated Cancer of Unknown Primary
Georges E Daoud1, Andre J Burnham2, Nikhil T Vettikattu2
1Department of Otolaryngology-Head and Neck Surgery, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Background:
The majority of lesions originally diagnosed as cancer of unknown primary (CUP) are eventually identified as HPV-associated oropharyngeal squamous cell carcinoma. Accurate primary tumor localization can facilitate targeted treatment or reduce adjuvant therapy.
Methods:
This retrospective study examined patients who underwent transoral robotic surgery (TORS) for CUP from 2019 to 2022 at a tertiary care center. We analyzed the primary tumor identification rate, recurrence rate, and need for adjuvant therapy.
Results:
A total of 48 patients with HPV-associated CUP underwent TORS, achieving an 87.5% identification rate (42/48). A total of 39.5% (19/48) avoided direct radiation to the primary site, and 20.8% (10/48) received no radiation. No patients had local recurrence, though three experienced regional or distant recurrence.
Conclusions:
A primary surgical approach to HPV-associated CUP of the head and neck should be considered in every patient with CUP. When combined with a robust frozen section pathology protocol helping to guide intraoperative decision-making and margin revision, and a multidisciplinary approach to adjuvant therapy, precise tumor localization can help appropriately direct adjuvant therapy.
Insights
Transoral robotic surgery (TORS) accurately identifies HPV-associated cancer of unknown primary (CUP) in the head and neck. This approach helps reduce the need for radiation therapy, improving patient outcomes.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Oncology
Background:
- Many cancers of unknown primary (CUP) are identified as HPV-associated oropharyngeal squamous cell carcinoma.
- Accurate primary tumor localization is crucial for effective treatment and reducing adjuvant therapy.
Purpose of the Study:
- To evaluate the efficacy of transoral robotic surgery (TORS) in identifying the primary tumor in patients with HPV-associated CUP.
- To assess recurrence rates and the necessity of adjuvant therapy following TORS for CUP.
Main Methods:
- Retrospective analysis of 48 patients with HPV-associated CUP who underwent TORS between 2019 and 2022.
- Evaluation of primary tumor identification rate, local recurrence, and adjuvant therapy requirements.
Main Results:
- TORS achieved an 87.5% primary tumor identification rate (42/48 patients).
- 39.5% of patients avoided direct radiation to the primary site, and 20.8% received no radiation.
- No local recurrences were observed, with three patients experiencing regional or distant recurrence.
Conclusions:
- A primary surgical approach, such as TORS, should be considered for all patients diagnosed with HPV-associated CUP.
- Precise tumor localization via TORS, guided by intraoperative pathology and a multidisciplinary approach, optimizes adjuvant therapy decisions.
