Advances in Surgical Therapy for HPV-Associated Squamous Cell Carcinoma

Purpose of Review: To review recent surgical advances in the treatment of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), specifically focusing on treatment strategies, patient outcomes, and surgical technologies. Recent Findings: Transoral robotic surgery (TORS) has become the surgical technique of choice when treating HPV-OPSCC. Patient-reported outcomes and functional outcomes are increasingly becoming drivers of treatment selection given the excellent prognosis of low-risk HPV-OPSCC. Decreased doses of adjuvant radiation therapy for select patients have been shown to be oncologically safe while offering the potential for improved functional outcomes. Neoadjuvant chemotherapy and immunotherapy have been shown to be safe in this patient population and may offer an advantage to up-front surgery. Finally, new data has identified circulating tumor HPV DNA (ctHPVDNA) as a promising biomarker of response to treatment in HPV-OPSCC. Summary: The treatment of HPV-OPSCC continues to evolve with surgery playing an increasingly important role. De-escalation of adjuvant treatment for select patients provides excellent oncologic control with the potential for decreased long-term toxicity and remains an area of ongoing investigation. Neoadjuvant therapy (chemotherapy and/or immunotherapy) and or biomarker-driven adjuvant therapy may play a significant role in future treatment paradigms using surgery.