HPV-related head and neck cancer: clinical features and implications for tumor staging and therapeutic strategies

Jos Straetmans

Research output: ThesisDoctoral ThesisExternal prepared

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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.
Original languageEnglish
Awarding Institution
  • Maastricht University
  • Kremer, B., Supervisor
  • Speel, Ernst, Supervisor
Award date10 Nov 2020
Place of PublicationMaastricht
Print ISBNs9789464161977
Publication statusPublished - 2020


  • Human papillomavirus
  • tonsils
  • carcinoma
  • nodal involvement
  • therapy


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