The Experts below are selected from a list of 4578 Experts worldwide ranked by ideXlab platform

Carole Fakhry - One of the best experts on this subject based on the ideXlab platform.

  • projected association of human papillomavirus vaccination with Oropharynx Cancer incidence in the us 2020 2045
    JAMA Oncology, 2021
    Co-Authors: Yuehan Zhang, Carole Fakhry, Gypsyamber Dsouza
    Abstract:

    Importance Oropharynx Cancer (OPC) incidence has increased for several decades in the US. It is unclear when and how this trend will be affected by current HPV vaccination trends. Objective To assess the association of HPV vaccination with future OPC incidence in the US. Design, setting, and participants This population-based age-period-cohort analysis obtained OPC incidence data from the Surveillance, Epidemiology, and End Results program from 69 562 patients 34 to 83 years of age diagnosed with OPC. The HPV vaccination data were obtained from the National Immunization Survey-Teen (60 124 participants) and National Health Interview Survey (16 904 participants). Data were collected from January 1, 1992, to December 31, 2017. Age-period-cohort forecasting models projected expected 2018 to 2045 OPC incidence under a counterfactual scenario of no HPV vaccination and current levels of HPV vaccination, stratifying by sex. Data analyses were completed by December 2020. Exposures Age- and sex-specific cumulative prevalence of HPV vaccination in 2016 to 2017 projected forward. Main outcomes and measures Projected OPC incidence and number of OPC cases expected to be prevented by HPV vaccination. Results Under current HPV vaccination rates, between 2018 and 2045, OPC incidence is projected to decrease in younger individuals (36-45 years of age: from 1.4 to 0.8 per 100 000 population; 46-55 years of age: from 8.7 to 7.2 per 100 000 population) but continue to increase among older individuals (70-83 years of age: from 16.8 to 29.0 per 100 000 population). The association of HPV vaccination with overall OPC incidence through 2045 will remain modest (no vaccination vs vaccination: 14.3 vs 13.8 per 100 000 population in 2045). By 2045 HPV vaccination is projected to reduce OPC incidence among individuals 36 to 45 years of age (men: 48.1%; women: 42.5%) and 46 to 55 years of age (men: 9.0%; women: 22.6%), but among those 56 years or older, rates are not meaningfully reduced. Between 2018 and 2045, a total of 6334 OPC cases will be prevented by HPV vaccination, of which 88.8% of such cases occur in younger age (≤55 years) groups. Conclusions and relevance According to the projections of this population-based age-period-cohort study, current HPV vaccination rates will have a limited association with overall OPC incidence through 2045 because older individuals who have not yet been vaccinated remain at high risk for OPC. However, reductions in OPC incidence should occur among young and middle-aged adults, the group at lowest risk of diagnosis. These findings forecast a continued shift in the landscape of OPC to an older population.

  • summary from an international Cancer seminar focused on human papillomavirus hpv positive Oropharynx Cancer convened by scientists at iarc and nci
    Oral Oncology, 2020
    Co-Authors: Aimee R Kreimer, Anil K. Chaturvedi, Gypsyamber Dsouza, Laia Alemany, Devasena Anantharaman, Freddie Bray, Mary Carrington, John Doorbar, Carole Fakhry
    Abstract:

    Cancer of the Oropharynx has attracted considerable attention in recent years given: (1) an increasing incidence in selected populations over the past three decades; (2) the discovery of human papillomavirus (HPV) infection as the driver of the increase, as opposed to the traditional risk factors such as tobacco (smoking and chewing) and alcohol; and (3) the promise of new prevention and treatment strategies. As a result of such developments, the International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI), convened the fourth Cancer Seminar meeting in November 2018 to focus on this topic. This report summarizes the proceedings: a review of recent science on the descriptive epidemiology, etiology, biology, genetics, early detection, pathology and treatment of HPV-positive oropharyngeal Cancer, and the formulation of key research questions to be addressed.

  • computed tomography performance in predicting extranodal extension in hpv positive Oropharynx Cancer
    Laryngoscope, 2020
    Co-Authors: Farhoud Faraji, Carole Fakhry, David W Eisele, Lisa M Rooper, Christine G Gourin, Nafi Aygun, Stephanie Coquia, Marietta Tan
    Abstract:

    OBJECTIVES To evaluate the performance characteristics of seven predetermined imaging features on pretreatment computed tomography (CT) in identifying extranodal extension (ENE) in cervical lymph node metastases from human papillomavirus-positive oropharyngeal carcinoma (HPV-OPC). STUDY DESIGN Retrospective study. METHODS Seventy-three patients with HPV-OPC who underwent primary surgery and cervical lymph node dissection were included. Preoperative contrast-enhanced CT (cCT) imaging was evaluated by two radiologists blinded to pathological results. Each cCT was scored for seven imaging features of interest: 1) indistinct capsular contours, 2) irregular nodal margins, 3) perinodal fat stranding, 4) perinodal fat planes, 5) nodal necrosis, 6) intranodal cysts, and 7) nodal matting. Logistic regression was employed to determine radiologist-specific odds ratios (OR) of predicting ENE for each imaging feature and radiologist-specific receiver operating characteristics (sensitivity [Sn], specificity [Sp], area under the curve [AUC], positive predictive value [PPV], negative predictive value [NPV]) for each imaging feature. RESULTS Thirty-two (44%) patients had ENE-positive lymph nodes. The presence of irregular margins (ORA = 12.3, 95% confidence interval [CI]A = 2.3-65.9; ORB = 7.0, 95% CIB = 1.4-36.3) and absence of perinodal fat plane (ORA = 6.8, 95% CIA = 2.0-23.3; ORB = 14.2, 95% CIB = 1.7-120.5) were significantly associated with ENE for each radiologist. Irregular nodal margin status was most specific for ENE (SnA = 45%, SpA = 94%, AUCA = 69%, PPVA = 82%, NPVA = 73%; SnB = 28%, SpB = 95%, AUCB = 61%, PPVB = 80%, NPVB = 64%). Absence of perinodal fat plane was most sensitive for ENE (SnA = 87%, SpA = 50%, AUCA = 69%, PPVA = 59%, NPVA = 62%; SnB = 96%, SpB = 34%, AUCB = 65%, PPVB = 53%, NPVB = 63%). CONCLUSIONS Of the seven imaging features hypothesized to be associated with ENE-status, the presence of irregular nodal margins and absence of perinodal fat plane were the most specific and sensitive features, respectively. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1479-1486, 2020.

  • tumor infiltrating lymphocyte quantification stratifies early stage human papillomavirus Oropharynx Cancer prognosis
    Laryngoscope, 2020
    Co-Authors: Farhoud Faraji, Nicholas Fung, Munfarid Zaidi, Christine C Gourin, David W Eisele, Lisa M Rooper, Carole Fakhry
    Abstract:

    OBJECTIVES/HYPOTHESIS: To evaluate if a simple method for assessing tumor-infiltrating lymphocytes (TIL) in primary tumor specimens improves the prognostic value of the American Joint Committee on Cancer, 8th Edition (AJCC8) Cancer staging system in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPC). STUDY DESIGN: Retrospective study. METHODS: In this study, TIL density was quantified on hematoxylin and eosin (HE aHR: 0.218; 95% CI: 0.058-0.822). TIL density similarly stratified risk in pathologically staged disease. CONCLUSIONS: In patients with AJCC8 stage I disease, low TIL density was associated with diminished RFS. Our data suggest that assessing TIL density on H&E-stained primary tumor specimens may enhance the prognostic resolution of the AJCC8 staging criteria for HPV-OPC. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

  • tumor infiltrating lymphocyte quantification stratifies early stage human papillomavirus Oropharynx Cancer prognosis
    Laryngoscope, 2020
    Co-Authors: Farhoud Faraji, Nicholas Fung, Munfarid Zaidi, Christine C Gourin, David W Eisele, Lisa M Rooper, Carole Fakhry
    Abstract:

    OBJECTIVES/HYPOTHESIS To evaluate if a simple method for assessing tumor-infiltrating lymphocytes (TIL) in primary tumor specimens improves the prognostic value of the American Joint Committee on Cancer, 8th Edition (AJCC8) Cancer staging system in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPC). STUDY DESIGN Retrospective study. METHODS In this study, TIL density was quantified on hematoxylin and eosin (HE aHR: 0.218; 95% CI: 0.058-0.822). TIL density similarly stratified risk in pathologically staged disease. CONCLUSIONS In patients with AJCC8 stage I disease, low TIL density was associated with diminished RFS. Our data suggest that assessing TIL density on H&E-stained primary tumor specimens may enhance the prognostic resolution of the AJCC8 staging criteria for HPV-OPC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:930-938, 2020.

Maura L. Gillison - One of the best experts on this subject based on the ideXlab platform.

  • phase ii randomized trial of transoral surgery and low dose intensity modulated radiation therapy in resectable p16 locally advanced Oropharynx Cancer an ecog acrin Cancer research group trial e3311
    Journal of Clinical Oncology, 2021
    Co-Authors: Robert L Ferris, Maura L. Gillison, Yael Flamand, Gregory S Weinstein, Harry Quon, Ranee Mehra, Joaquin J Garcia, Christine H Chung, Umamaheswar Duvvuri, Bert W Omalley
    Abstract:

    PURPOSEDefinitive or postoperative chemoradiation (CRT) is curative for human papillomavirus–associated (HPV+) Oropharynx Cancer (OPC) but induces significant toxicity. As a deintensification strat...

  • transoral robotic surgical resection followed by randomization to low or standard dose imrt in resectable p16 locally advanced Oropharynx Cancer a trial of the ecog acrin Cancer research group e3311
    Journal of Clinical Oncology, 2020
    Co-Authors: Robert L Ferris, Maura L. Gillison, Yael Flamand, Gregory S Weinstein, Harry Quon, Ranee Mehra, Joaquin J Garcia, Christine H Chung, Umamaheswar Duvvuri, Bert W Omalley
    Abstract:

    6500Background: ECOG-ACRIN 3311 examines reduced postoperative therapy in patients with “intermediate risk” p16+ Oropharynx Cancer (OPC) undergoing primary transoral surgical management. We report ...

  • Development and validation of an individualized risk prediction model for Oropharynx Cancer in the US population
    Cancer, 2019
    Co-Authors: Joseph E. Tota, Maura L. Gillison, Hormuzd A. Katki, Lisa Kahle, Robert K. L. Pickard, Weihong Xiao, Bo Jiang, Barry I. Graubard, Anil K. Chaturvedi
    Abstract:

    BACKGROUND The incidence of Oropharynx Cancers has increased substantially in the United States. However, risk stratification tools for the identification of high-risk individuals do not exist. In this study, an individualized risk prediction model was developed and validated for Oropharynx Cancers in the US population. METHODS A synthetic, US population-based case-control study was conducted. Oropharynx Cancer cases diagnosed at Ohio State University (n = 241) were propensity-weighted to represent Oropharynx Cancers occurring annually in the United States during 2009-2014 (n = 12,656). Controls (n = 9327) included participants in the National Health and Nutrition Examination Survey (2009-2014) and represented the annual US population aged 30 to 69 years (n = 154,532,508). The individualized 1-year absolute risk of Oropharynx Cancer was estimated with weighted logistic regression. RESULTS The risk prediction model included age, sex, race, smoking, alcohol use, lifetime sexual partners, and oral oncogenic human papillomavirus (HPV) status. The model had good discrimination and calibration in split-sample validation (area under the curve [AUC], 0.94; 95% confidence interval [CI], 0.92-0.97; observed/expected [O/E], 1.01; 95% CI, 0.70-1.32) and external validation (AUC, 0.87; 95% CI, 0.84-0.90; O/E, 1.08; 95% CI, 0.77-1.39). In the US population, 1-year predicted risks of Oropharynx Cancer were highest for older individuals (21.1/100,000 for 65- to 69-year-olds), men (13.9/100,000), whites (10.4/100,000), smokers (18.0/100,000 for >20 pack-years), heavy alcohol users (18.4/100,000), and those with prevalent oral oncogenic HPV (140.4/100,000). The risk prediction model provided substantial risk stratification, with approximately 77% of all Oropharynx Cancers and approximately 99% of HPV-positive Oropharynx Cancers occurring in the 10% of the US population with the highest model-predicted risk. CONCLUSIONS This risk prediction model will enable the efficient design of studies to address the outstanding questions pertaining to the natural history, screening, and secondary prevention of Oropharynx Cancers.

  • evolution of the Oropharynx Cancer epidemic in the united states moderation of increasing incidence in younger individuals and shift in the burden to older individuals
    Journal of Clinical Oncology, 2019
    Co-Authors: Joseph E. Tota, Maura L. Gillison, Ana F Best, Zachary S Zumsteg, Philip S Rosenberg, Anil K. Chaturvedi
    Abstract:

    PURPOSEHuman papillomavirus–positive Oropharynx Cancer incidence has increased rapidly in cohorts of US white men born during the 1930s to 1950s. It is unknown how the trajectory of the Oropharynx ...

  • Burden of HPV-positive Oropharynx Cancers among ever and never smokers in the U.S. population
    Oral Oncology, 2016
    Co-Authors: Anil K. Chaturvedi, Gypsyamber D'souza, Maura L. Gillison, Hormuzd A. Katki
    Abstract:

    Summary Background HPV-positive Oropharynx Cancer is frequently characterized as a disease of never-smokers due to higher HPV prevalence in Oropharynx tumors among never-smokers than ever-smokers. We sought to estimate the burden (incidence rates and case counts) of HPV-positive Oropharynx Cancers among never, former, and current smokers in the US population by combining data from several sources. Methods We decomposed the SEER population-level incidence of Oropharynx Cancers into rates among never-, former-, and current-smokers using a formula based upon rate ratios (RR) for the smoking-Oropharynx Cancer association (NIH-AARP cohort study) and smoking prevalence in the U.S. population (NHANES 2007/2008). These rates were multiplied by smoking strata-specific HPV prevalence in Oropharynx Cancer patients (RTOG0129) to estimate incidence of HPV-positive and HPV-negative Oropharynx Cancers, which were applied to the US population of smokers to calculate annual case counts. Analyses were conducted overall and gender-stratified. Results The incidence of HPV-positive Oropharynx Cancers was significantly higher among ever versus never-smokers in the US population aged 20+ years during 2007/2008 (RR = 1.81; 95%CI = 1.32–2.47), including significantly higher incidence in current smokers (RR = 2.26; 95%CI = 1.60–3.21) and former smokers (RR = 1.38; 95%CI = 1.02–1.85). Of the estimated 6677 (5418 in men and 1259 in women) annually incident HPV-positive Oropharynx Cancers in the U.S during 2007/2008, 63.3% arose among ever smokers and 36.7% among never-smokers (p  Conclusions The population-level burden of HPV-positive Oropharynx Cancers is significantly higher among ever-smokers than never-smokers in the U.S.

Robert L Ferris - One of the best experts on this subject based on the ideXlab platform.

William R Ryan - One of the best experts on this subject based on the ideXlab platform.

  • risk of pathologic extranodal extension and other adverse features after transoral robotic surgery in patients with hpv positive Oropharynx Cancer
    Archives of Otolaryngology-head & Neck Surgery, 2021
    Co-Authors: Aaron L Zebolsky, Chase M Heaton, Elizabeth George, Arushi Gulati, Katherine C Wai, Patrick S Carpenter, Annemieke Van Zante, William R Ryan
    Abstract:

    Importance Understanding patient-specific risk of adverse histopathologic findings after primary surgery for human papillomavirus (HPV)-positive Oropharynx squamous cell carcinoma (OPSCC) may help guide patient consultations. Objective To determine the likelihood of adverse histopathologic features that may indicate adjuvant radiotherapy or chemoradiotherapy after primary surgery for HPV-positive OPSCC according to 2021 National Comprehensive Cancer Network guidelines. Design, Setting, and Participants This retrospective cohort study was performed at a single academic tertiary care center. Of 258 patients who underwent transoral robotic surgery (TORS) from March 1, 2012, to March 1, 2021, 136 consecutive, treatment-naive patients with HPV-positive OPSCC without obvious clinical extranodal extension (ENE) who underwent definitive TORS and neck dissection were included in the analysis. Indications for surgical treatment included non–deeply infiltrative Oropharynx tumors, minimal soft palate involvement, and low suspicion for pathologic ENE. Exposures Primary site TORS with neck dissection. Main Outcomes and Measures The primary outcomes were the adverse histopathologic features of pathologic ENE and positive surgical margins (PSM) that are indications for possible adjuvant chemoradiotherapy. Outcomes were compared among varying American Joint Committee on Cancer 7th edition (AJCC-7) T and N categories and patient clinical characteristics. Results Of the 136 patients included in the analysis (113 men [83.1%]; median age, 63 [interquartile range, 55-70] years), 109 (80.1%) had at least 1 indication for possible adjuvant radiotherapy. Twenty-seven patients (19.9%) had pathologic ENE and 10 (7.3%) had PSM. Thirty-four patients (25.0%) had pathologic ENE and/or PSM, whereas 3 (2.2%) had both. Age, smoking history, history of alcohol consumption, and clinical T category were not associated with pathologic ENE, PSM, lymphovascular invasion, perineural invasion, or pN2 category or greater. The proportion of pathologic ENE varied by clinical N category: 0 of 16 for cN0, 8 of 48 (16.7%) for cN1, 3 of 23 (13.0%) for cN2a, and 16 of 45 (35.6%) for cN2b. Compared with patients with cN1-cN2a disease, patients with cN2b disease had higher odds of pathologic ENE (odds ratio, 3.01; 95% CI, 1.14-8.10). Clinical and pathologic N category were concordant in 77 patients (56.6%), whereas 42 (30.9%) were upstaged and 17 (12.5%) were downstaged. Conclusions and Relevance In this cohort study, approximately one-quarter of carefully selected patients with HPV-positive OPSCC without obvious clinical ENE undergoing primary surgery had pathologic ENE and/or PSM. Patients with AJCC-7 cT0-cT2 cN0-cN2b disease, especially cN0-cN2a, without signs of clinical ENE may represent appropriate candidates for primary surgery when avoidance of adjuvant chemotherapy and/or reduction of adjuvant radiotherapy dose/extent are the goals.

  • patterns of nodal metastases and predictors of occult disease in hpv associated Oropharynx Cancer
    Otolaryngology-Head and Neck Surgery, 2021
    Co-Authors: Gaelen Stanfordmoore, Edgar Ochoa, Andrew R Larson, Mary Han, Kathryn R Hoppe, William R Ryan
    Abstract:

    ObjectiveFor human papilloma virus–associated Oropharynx squamous cell carcinoma (HPV+ OPSCC), we evaluated the distribution of neck-level lymph node (LN) metastasis, based on postsurgical histopat...

  • treatment modality impact on quality of life for human papillomavirus associated Oropharynx Cancer
    Laryngoscope, 2020
    Co-Authors: Karolina Plonowska, Zev R Gurman, Amanda K Humphrey, Steven J Wang, Ivan H Elsayed, Chase M Heaton, Jonathan R George, Sue S Yom, Alain Algazi, William R Ryan
    Abstract:

    Objectives/hypothesis Compare treatment-related quality of life (QOL) impact for early-stage human papillomavirus-associated Oropharynx squamous cell carcinoma (HPV+ OPSCC) patients. Study design Retrospective cohort at a tertiary center. Methods Stage I (T0-2/N0-1) HPV+ OPSCC patients (n = 76) with pretreatment Karnofsky scores ≥80 reported QOL after surgery alone (n = 17, 22%), surgery with adjuvant radiation ± chemotherapy (S-a[C]XRT) (n = 23, 30%), or definitive radiation ± chemotherapy (d[C]XRT) (n = 36, 47%) with the University of Washington QOL version 4 (UW-QOL); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (EORTC QLQ-C30) and Head and Neck Module (EORTC QLQ-HN35); University of Michigan Xerostomia, and Neck Dissection Impairment Index questionnaires (median follow-up = 2.2 years, interquartile range = 1.0-4.2 years). Treatment adverse events and gastrostomy tube rates were assessed. Results Over 87% of each treatment group reported good or better overall QOL. Each group had low gastrostomy tube and treatment-specific complication rates. S-a(C)XRT and d(C)XRT patients had similar mean scores with wide ranges for most individual and all composite categories. S-a(C)XRT compared to d(C)XRT patients reported significantly fewer dental problems (EORTC QLQ-C30/HN35 means = 10.1 vs. 34.3, P = .007), worse appearance (UW-QOL means = 72.8 vs. 82.6, P = .02), and worse coughing (EORTC QLQ-C30/HN35 means = 31.9 vs. 15.7, P = .007). Surgery alone compared to d(C)XRT and S-a(C)XRT patients reported significantly better salivary/taste/oral functions and less pain, financial, oral/dental, and sexual problems. Conclusions For early-stage HPV+ OPSCC, patients usually achieve acceptable QOL regardless of treatment. S-a(C)XRT and d(C)XRT patients report generally similar QOL including neck/shoulder pain/function, but with a wide range in a limited patient sample. Surgery alone should be considered, when oncologically and functionally safe, given the better associated QOL. Level of evidence 4 Laryngoscope, 130:E48-E56, 2020.

Bert W Omalley - One of the best experts on this subject based on the ideXlab platform.