Current evidence and future directions in the surveillance of HPV-positive oropharyngeal carcinoma.

INTRODUCTION

Human papilloma virus positive (HPV+) OPSCC has a favorable prognosis compared to its HPV- carcinomas but a significant proportion of patients will experience disease recurrence and death. Enhancement of surveillance strategies after treatment for primary HPV + OPSCC is of great importance.

AREAS COVERED: The aim of this paper is to provide an updated synthesis of the current state of evidence on the surveillance of HPV+ OPSCC and provide guidance on future directions on this topic. Basic and clinical research efforts are directed on various aspects of surveillance, including but not limited to patterns of recurrence, radiology, circulating tumor HPV DNA, and follow-up strategies.

EXPERT OPINION: The majority of OPSCC recurrences are detected by patients or during follow-up imaging. Rarely, recurrences are detected during the visits. Routine clinical surveillance can be scheduled once every 3 months in the first year, once every 6 months in the second year, and then annually up to year 5. Regarding imaging surveillance, positron emission tomography-computed tomography (PET-CT) of the head, neck, and chest is the most widely recommended modality. Current guidelines recommend one imaging at 3 months post-treatment, with subsequent imaging at the discretion of the clinician. Circulating HPV-DNA is an emerging technology that can be integrated soon into daily clinical practice.