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Background/aim: Current guidelines derived from a pre-human papilloma virus (HPV) era in oropharyngeal cancer do not recommend routine surveillance imaging. We aimed to analyze the method of recurrence detection in HPV+ disease to determine a role for follow-up imaging., Patients and Methods: All HPV+ and HPV- oropharyngeal cancer patients treated at our institution from 2005-2016 with biopsy-proven recurrence were identified and their method of recurrence detection was analyzed., Results: A total of 16 HPV+ oropharyngeal cancer patients were identified to have recurrence, 12 (75%) of which experienced distant recurrence and 13 (81.3%) were detected asymptomatically with imaging at a median time of 19.7 months after initial treatment and verifying no residual disease. Twelve (75%) detections were with PET-CT. While HPV- patients (17 patients) also have a high rate of asymptomatic detection (16 patients, 94.1%), their 3-year post-recurrence survival was significantly lower at 6.5% compared to 83.6% for the HPV+ group (p<0.01)., Conclusion: In HPV+ patients, a large proportion of failures are asymptomatic distant metastases, which occur beyond 6 months following treatment completion, and are detected with whole body imaging alone. In light of long term post-recurrence survival observed, this preliminary data suggests that routine surveillance imaging should be further studied for HPV+ disease., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Elderly patients with HPV+ oropharyngeal cancer (OPC) represent an understudied cohort of the HPV epidemic. We aimed to investigate the clinical presentation, treatment tolerability and outcomes in patient's ≥65 years old with HPV+ OPC., Patients and Methods: We identified all patients aged 65 and older treated at our Institution with HPV+ OPC and analyzed patient demographics, disease characteristics, treatment modalities, toxicities, treatment failures, and survival. Charlson comorbidity index was calculated for each patient., Results: 43 patients were identified with a mean age of median age was 70.0 (range 65-86). The mean Charlson comorbidity index score for the cohort was 5.2. In total, 72.1% of patients received what was considered standard-of-care based on stage and pathological features. Nine point three percent of patients required RT-related treatment breaks with the majority being women (75%). Three-year actuarial overall survival was 85.5% (95% CI: 71.4%-100%) and 3-year disease-free survival was 67.3% (95% CI: 49.7-91.0%)., Conclusion: This study presented one of the largest series to date evaluating HPV-related OPC in patients ≥65. Elderly individuals with HPV+ OPC have favorable overall survival with high treatment tolerability independent of Charlson co-morbidity score. Elderly patients should be considered for stage-appropriate care with omission of specific therapies based on absolute contraindications and patient preference, but not assumptions regarding tolerability., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)