Humaan Papillomavirus en hoofd/halskanker. Pol Specenier

Transcription

1 Humaan Papillomavirus en hoofd/halskanker Pol Specenier

2 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

3 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

4

5 Incidence Belgium

6 Mortality Belgium

7 Incidence Head and Neck Cancer Belgium 2011 Lip, oral cavity and pharynx, NOS Mouth, NOS Palate Floor of mouth Gum Tongue Base of tongue Lip Oropharynx Tonsil Hypopharynx Males Females Pyriform sinus Larynx Nasopharynx Accessory sinuses Nasal cavity and middle ear Salivary glands, NOS Parotid gland

8 Incidence Head and Neck Cancer Belgium 2011 Lip, oral cavity and pharynx, NOS Mouth, NOS Palate Floor of mouth Squamous Cell Carcinoma (SCCHN) Gum Tongue Base of tongue Lip Oropharynx Tonsil Hypopharynx Males Females Pyriform sinus Larynx Nasopharynx Accessory sinuses Nasal cavity and middle ear Salivary glands, NOS Parotid gland

9 Incidence Head and Neck Cancer Belgium 2011 Lip, oral cavity and pharynx, NOS Mouth, NOS Palate Floor of mouth Squamous Cell Carcinoma (SCCHN) Gum Tongue Base of tongue Lip Oropharynx Tonsil Hypopharynx Males Females Pyriform sinus Larynx Nasopharynx Accessory sinuses Nasal cavity and middle ear Salivary glands, NOS Parotid gland

10 Fraction of SCCHN due to alcohol, tobacco, or both Tobacco + alcohol Tobacco alone Alcohol alone

11 Fraction of SCCHN due to alcohol, tobacco, or both Tobacco + alcohol Tobacco alone Alcohol alone

12 Tobacco Smoking and Head and Neck Cancer: INHANCE Wyss A et al. Am J Epidemiol. 2013; 178(5):679-90

13 Involuntary Tobacco Smoking and UADT Lee YCA et al. Cancer Epidemiol Biomarkers Prev 2009;18:

14 Marron M et al. Int J Epidemiol. 2010; 39(1):182-96

15 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

16

17 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

18 Incidence oropharyngeal cancer Chaturvedi AK. Head and Neck Pathol 2012; 6:S16 S24

19 Oropharyngeal cancer incidence: US Oropharynx Oral cavity Larynx Chaturvedi AK et al. J Clin Oncol 2011; 29:

20 Oropharyngeal cancer incidence: Sweden Ramqvist T, Dalianis T. Emerg Infect Dis. 2010; 16(11):1671-7

21 Incidence HPV+ and HPV- tonsillar SCC: Sweden Ramqvist T, Dalianis T. Emerg Infect Dis. 2010; 16(11):1671-7

22 Proportion HPV+ tumors Marur S et al. Lancet Oncol 2010; 11:

23 HPV status and prognosis Rietbergen MM et al. Int J Cancer 2013; 132:

24 Prevalence HPV markers according to tumor site Combes JD, Franceschi S. Oral Oncol 2013;

25 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

26 HPV Kleine niet-omkapselde DNA virussen, dubbelstrengig genoom dat codeert voor 6 vroege (E1, E2, E4, E5, E6, E7) 2 late proteinen (L1, L2) Best SR et al. Otolaryngol Clin North Am 2012; 45(4):

27 HPV E6 oncoproteine leidt tot ubiquinatie en degradatie tumor suppressor p53 deregulatie van de G1/S and G2/M cell cycle checkpoints Ghittoni R et al. Virus Genes 2010; 40:1 13; Narisawa-Saito M et al. Cancer Sci 2007; 98: ; Best SR et al. Otolaryngol Clin North Am 2012; 45(4):

28 HPV E7 oncoproteine: degradatie retinoblastoma tumor suppressor gene product (prb) (E5 zorgt voor upregulatie EGFR) Ghittoni R et al. Virus Genes 2010; 40:1 13; Narisawa-Saito M et al. Cancer Sci 2007; 98: ; Best SR et al. Otolaryngol Clin North Am 2012; 45(4):

29 HPV-related cancer cases US 2009 Jemal A et al. J Natl Cancer Inst 2013;105:

30 Incidence cervical and oropharyngeal cancer Chaturvedi AK et al. J Clin Oncol 2011; 29:

31 Bosch FX et al. Vaccine 2013; 31S: H1 H31

32 Oral HPV infection prevalence Kreimer AR et al. Cancer Epidemiol Biomarkers Prev 2011;20:

33 Oral HPV infection prevalence Chung CH et al. Oral Oncol 2013; j.oraloncology

34 Oral HPV infection prevalence Gillison ML et al. JAMA 2012; 307:

35 Oral HPV infection prevalence Gillison ML et al. JAMA 2012; 307:

36 HPV + and tumors: characteristics Marur S et al. Lancet Oncol 2010; 11:

37 Lewis JS et al. Am J Surg Pathol. 2010; 34(8): doi: /pas.0b013e3181e84652

38 Zandberg DP et al. CA Cancer J Clin 2013;63:57-81.

39 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

40 HPV and prognosis Chaturvedi AK. Head and Neck Pathol 2012; 6:S16 S24

41 HPV and survival: RTOG 0129 Ang KK et al. N Engl J Med 2010;363:24-35

42 HPV and survival: RTOG 0129 HPV-16 DNA ISH HPV-16 negative 12 additional oncogenic HPV types (18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) p16 ICH; positive = strong and diffuse nuclear and cytoplasmic staining in 70% or more of the tumor cells Ang KK et al. N Engl J Med 2010;363:24-35 Lassen P et al. Radiother Oncol 2013; 108:

43 Correlatie p16 en HPV Kappa = 0.8; 95 % CI: Ang KK et al. N Engl J Med 2010;363:24-35

44 HPV and survival: RTOG 0129 Ang KK et al. N Engl J Med 2010;363:24-35 HPV-16: 96.1 %

45 HPV and survival: RTOG 0129 Ang KK et al. N Engl J Med 2010;363:24-35

46 HPV and survival: RTOG 0129 Ang KK et al. N Engl J Med 2010;363:24-35

47 HPV and prognosis TAX 324 TROG Rischin R et al. J Clin Oncol 2010; 28: Posner MR et al. Ann Oncol 2011; 22:

48 HPV and prognosis Fischer CA et al. Ann Oncol 2010; 21:

49 HPV detectie technieken Mirghani H et al. Oral Oncol

50 Mirghani H et al. Oral Oncol

51 Mirghani H et al. Oral Oncol

52 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

53 Pathologist Surgeon Medical Oncologist Radiotherapist Dietician GP Patient Radiologist Dentist Social worker Speech Therapist Nurse Psychologist

54 Oropharyngeal cancer: treatment

55 Oropharyngeal cancer: treatment

56 Oropharyngeal cancer: treatment

57 MACH-NC: concomitant CRT Pignon JP et al. Radiother Oncol 2009; 92: 4 14

58 Oropharyngeal cancer: treatment

59 Oropharyngeal cancer: treatment

60 Oropharyngeal cancer: treatment

61 Bernier J et al. Head Neck 2005; 27:

62 Oropharyngeal cancer: treatment

63 De-escalation? Kofler B et al. Eur Arch Otorhinolaryngol DOI /s

64 Kofler B et al. Eur Arch Otorhinolaryngol DOI /s

65 Humaan Papillomavirus en hoofd/halskanker Hoofd/halskanker: incidentie en oorzaken Oropharynx carcinoom Incidentie HPV HPV en prognose Behandeling Preventie

66 HPV types in oropharyngeal cancer Kreimer AR et al. Cancer Epidemiol Biomarkers Prev 2005;14: Kreimer AR et al. Cancer Epidemiol Biomarkers Prev 2005;14: Kreimer AR et al. Cancer Epidemiol Biomarkers Prev 2005;14:

67 Herrero Ret al. PLoS One Jul 17;8(7):e doi: / journal.pone

68 Prevalence oral infections HPV16/18 Herrero Ret al. PLoS One Jul 17;8(7):e doi: / journal.pone

69 Oral infections HPV other than 16/18 Herrero Ret al. PLoS One Jul 17;8(7):e doi: / journal.pone

70 Dank U

71 HPV status and EGFR expression Mirghani H et al. Eur J Cancer 2014;

72 HPV status and EGFR expression Lassen P et al. Radiother Oncol 2013; 108:

73 Robinson M et al. Head and Neck Pathol 2012; 6: S83 S90

74 HPV attributable cancers : US MMWR. 2012; 61 (15)

75 Tobacco Smoking and Head and Neck Cancer: INHANCE Wyss A et al. Am J Epidemiol. 2013; 178(5):679-90

76

77 Alcoholic Beverage and Head and Neck Cancer: INHANCE Purdue MP et al. Am J Epidemiol 2009; 169(2):132-42

78 Alcohol-tobacco interaction

79

80 Kreimer AR et al. Cancer Epidemiol Biomarkers Prev 2005;14:

81

82