Lawrence E. Ginsberg
The topic was chosen because we are witnessing a tsunami of HPV-associated oropharyngeal cancers. As smoking-related head-and-neck malignancies wane (along with lung cancer), oropharyngeal cancer is on the upswing.
Earlier work in AJNR, also authored by my colleague Dr. Sarah Cantrell, focused on radiologic differences between HPV-positive and HPV-negative oropharyngeal cancers. However, in the several years since that publication, old-school (HPV-negative) oropharyngeal cancers are increasingly difficult to find, and so we focused on a potential way to discriminate between higher- and lower-risk populations among the HPV-positive cancers. Because smokers are known to fare worse, and matted lymphadenopathy has been identified as an independent adverse prognosticator, we sought a link between smokers and the appearance of nodal disease in their necks. Alas, we could find no such association. It’s hard to know how this is influencing our practice or those of others, and feedback has been limited. We continue to seek ways of identifying a worse prognosis in an effort to prevent treatment de-intensification in this subgroup, and to be wary of aggressive disease behavior.