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In head and neck cancer (HNC), Human Papilloma Virus (HPV)-negative disease is usually associated with smoking and alcohol use and relatively poor survival. Robert Ferris, MD, notes that there have not been significant improvements in survival for these patients. Current standard of therapy includes cisplatin for 3 cycles, where each cycle is 21 days, combined with daily radiotherapy, although the US oncologic community has recently shifted to weekly cisplatin with daily radiotherapy. In an effort to improve overall survival for these patients, researchers are testing induction regimens that involve 2- or 3-chemotherapy agents followed by chemoradiation.
Within HPV-negative HNC is a unique subpopulation of patients who present with oral cavity tumors, whose incidence has increased in recent years. Barbara Murphy, MD, notes that it is important for clinicians to recognize that these oral cavity tumors primarily affect the tongue and occur predominantly in women. Surgery is the primary treatment, which Murphy emphasizes needs to be performed adequately from the beginning. Some clinicians are hesitant to remove too much of a patient’s tongue due to concern of worsening function, so they opt for radiation or radiation combined with chemotherapy, which evidence demonstrates are inferior alternatives to surgery.