The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased during the past 3 decades, and an increasing proportion of OPSCC cases are human papillomavirus (HPV) positive.¹ Compared with traditional, HPV-negative OPSCC, HPV-positive OPSCC is a unique clinical entity that affects a younger population of patients who often lack the traditional risk factors of heavy tobacco and alcohol exposure.² In addition, HPV-positive OPSCC has an overall better prognosis than HPV-negative OPSCC, a distinction with important implications for disease management.³ Identifying the prognostic power of pertinent clinical and pathologic variables is at the forefront of clinical research, and treatment deescalation strategies are being applied to some HPV-positive patients to minimize treatment-related morbidity.⁴

With the rapidly increasing prevalence of oropharyngeal squamous cell carcinoma (OPSCC), largely driven by the human papillomavirus (HPV) epidemic, and with relative equipoise between radiation-based and surgery-based treatment protocols, there has been renewed interest in describing differences in functional outcomes between the 2 treatment modalities. Radiation is theoretically related to stroke risk due to carotid artery intimal injury, which could lead to the development of atherosclerosis. Both carotid artery stenosis and carotid intima-medial thickness have been shown to be associated with radiation therapy providing a biologic basis for the findings.¹ A retrospective population-based cohort study of veterans with OPSCC authored by Sun et al² reported a 12.5% imputed stroke risk within 10 years after treatment. The major finding of this study is that there was an observed 23% relative risk reduction of stroke in patients treated with definitive surgery as compared with those treated with definitive radiotherapy. Although there were notable differences between the groups at baseline, in particular higher T- and N-stage as well as worse ECOG performance status and Charlson Comorbidity Index in the nonsurgical group, the authors conducted propensity score–based analyses to account for these imbalances. Interestingly, there was no increase in stroke risk among surgical patients treated with adjuvant radiation as compared with those treated with surgery alone. (Other population-based studies have observed the same.) Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.

Although HPV status is known to provide an improved prognosis in initial treatments of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), it is unclear how it affects patients who receive salvage surgery (SS), which has historically poor survival rates. The purpose of this study was to evaluate the role of SS for patients with locoregional recurrence (LRR) of HPV-positive OPSCC and its impact survival rates. We conducted a scoping review of literature through October 2022 and included 995 individuals. Survival endpoints, such as overall survival (OS), Kaplan–Meier curves, and median post-recurrence survival, were analyzed in addition to demographics. Of all studies, 18.8% (6/32) reported any survival data for SS patients, with the most prevalent reporting 2- and 5-year OS in two studies. Median post-recurrence survival was not reported for SS. These findings reveal the limited and unpredictable reporting of survival-specific data on SS for HPV-positive OPSCC. With limited survival assessment, it is difficult to assess the potential advantages and disadvantages of this therapy to guide clinical decision-making.

In patients receiving treatment for head and neck cancer (HNC), there is a correlation between quality of life (QoL) scores and treatment outcomes. Higher QoL scores have been associated with improved survival. Despite this, the assessment of QoL in clinical trials varies considerably. Three databases (Scopus, PubMed, and Cinahl) were queried for articles published in English between 2006 and 2022. Two reviewers (SRS and ANT) performed study screening, data extraction, and risk of bias assessment. The authors identified 21 articles that met the inclusion criteria. A total of 5961 patients were evaluated. QoL was reported as average scores for specific variables across five different surveys in 12 included articles. Supplemental QoL data were available in 10 included studies. Critical appraisal of studies indicated a high risk of bias due to the inclusion of trials. There is no standard method for reporting QoL data in clinical trials for HNC patients undergoing treatment with anti-EGFR inhibitors. Future clinical trials should standardize their method for assessing and reporting quality-of-life data to increase patient-centered care and refine treatment choices to optimize survival.