In this dissertation, head and neck tumours caused by the human papillomavirus (HPV) were studied. The ‘tracing’ role of the HPV-positive cervical lymph nodes that provide an early indication of a smaller primary oropharyngeal tumour was discovered. The data showed such a reduced prognostic value of the HPV-positive lymph gland that an adaptation of the TNM classification necessitated a separate staging for HPV-related oropharyngeal tumours. The addition of non-anatomic parameters (smoking habits, age) to this staging allows for a more careful stratification of treatment groups, for example, when investigating outcomes of the promising HPV-targeted immunomodulation. This dissertation further shows that HPV-targeted diagnostics are currently based on a balance between accuracy and clinical applicability, and that both components need improvement. In lymph node metastases of unknown primary tumours, HPV diagnostics do not contribute to a more accurate detection of the primary tumour. However, de-escalation of irradiation volumes appears to be safe (i.e. without pharyngeal axis, and control side neck, in glands <3cm), which leads to less disease burden in this group.
|Award date||10 Nov 2020|
|Place of Publication||Maastricht|
|Publication status||Published - 2020|
- Human papillomavirus
- nodal involvement