Prognosis

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Kanker van de mondholte: diagnose, behandeling en follow-upPublished by: KCELast published: 2015Cancers de la cavité buccale : diagnostic, traitement et suiviPublished by: KCELast published: 2015

Survival after definitive treatment for oropharyngeal carcinoma depends principally on the stage of disease and ability to undergo standard treatment. Patients who are positive for high-risk human papillomavirus (HPV) have a better survival.[7][80][81]​​[119][120]

Young age (<50 years) is also associated with a better cancer-specific survival compared with older age (>50 years) for tonsillar carcinoma. It is unclear whether the benefit associated with young age is related to a high prevalence of HPV-16 in this patient population or better tolerance to treatment.[121] Survival for early stage oropharyngeal cancer is excellent, ranging from 80% to 90% at 5 years.[75][76][122][123]​​​ Morbidity and mortality of treatment is the major selecting factor between surgery and radiation. For locally advanced resectable disease, survival ranges from 60% to 70% at 3 years.[88][124]​​​ For locally unresectable disease, 3-year survival ranges from 40% to 55%.[91][92][93][94][95][96][97]​​​ Patients with metastatic disease have a poor prognosis with median survival of about 10 months.​[125]​​

New radiation therapy techniques, such as intensity-modulated radiation therapy (IMRT), have the potential to improve patient quality of life because of their sparing effects on normal tissue. The National Comprehensive Cancer Network (NCCN) recommends IMRT to minimize damage to critical structures.[2]​ Lower rates of xerostomia have been reported when patients with head and neck cancers were treated with IMRT, without compromise on local disease control or survival. The incidence of dysphagia and aspiration may also be reduced due to its sparing effects on the pharyngeal muscles.[126]

The patient's current and previous smoking status, including number of packs/day, at the time of diagnosis impact the survival rate of patients with oropharyngeal squamous cell carcinoma, independent of HPV negative status.[127] In addition, tobacco exposure can eliminate any survival benefit associated with HPV positive status in patients with oropharyngeal squamous cell carcinoma.[128]

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