An update of staging guidelines from the American Joint Committee on Cancer (AJCC) for human papillomavirus (HPV)-positive throat cancer—now more common in the United States than cervical cancer, according to the American Cancer Society—aims to make treatment of early-stage disease more consistent and appropriate. The update was published by Ho et al in The Lancet Oncology.
“Staging helps clinicians answer two questions,” said Allen Ho, MD, PhD, Professor of Surgery and Director of the Head and Neck Cancer Program at Cedars-Sinai and lead author of the study. “The first: How serious is the cancer? The second: What is the best treatment?”
Previous staging guidelines for HPV-positive throat cancer were so broad that as many as 80% of patients were classified as stage 1, with three different possible treatment strategies. Some patients considered to have stage 1 disease were treated with surgery alone, some with surgery plus radiation therapy, and some with surgery and radiation plus chemotherapy.
“The new staging will better inform clinicians and patients about a patient’s prognosis and will minimize inconsistencies in the treatments patients are offered,” Dr. Ho said. “Currently, a patient diagnosed as stage 1 might be offered surgery plus radiation and chemotherapy, while another stage 1 patient may be offered surgery alone. The new guidelines will help ensure each patient receives the most appropriate treatment.”
Investigators divided the large group of patients diagnosed as stage 1 into three separate groups, Dr. Ho said. They created new subdivisions of nodal staging and paired a more cohesive treatment recommendation with each.
“Perhaps the biggest change in the new staging system is that it takes into account something called extranodal extension, where the cancer has not only spread to the lymph nodes, but has progressed further to destroy the lymph node capsule and spill into the surrounding tissue. Inclusion of this factor is important, because it often changes both prognosis and the recommended treatment following surgery,” said Zachary Zumsteg, MD, Professor of Radiation Oncology and Biomedical Sciences at Cedars-Sinai and senior author of the paper.
Dr. Ho noted that cases of HPV-positive throat cancer (caused by the same virus that causes cervical cancer) have outpaced cervical cancer, because women are routinely screened for cervical cancer. Women are also more likely than men to receive the HPV vaccine, which can prevent both cancer types.
The new guidelines were developed by an international committee that analyzed data on more than 14,000 patients from 984 health-care facilities. They are set to become the official worldwide staging guidance in the coming year.
Dr. Ho suggested that patients with newly diagnosed HPV-positive throat cancer ask their care team how these new guidelines have shaped their staging and treatment options. “Patients should ask their [health-care providers] how these new guidelines impact the clinician’s thinking about the patient’s staging, prognosis, and which treatment to offer,” he concluded.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
