Management of Recurrent HPV-Positive Oropharyngeal Squamous Cell Carcinoma: a Contemporary Review.

PURPOSE OF REVIEW: To review the impact of contemporary treatment strategies on salvage outcomes in patients with recurrent human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). RECENT FINDINGS: Secondary to HPV, changes in disease biology have impacted primary treatments and subsequent approaches to patients with recurrence. With treatment strategies more inclusive of upfront surgery, the characteristics of patients with recurrence HPV + OPSCC have been further redefined. Less invasive endoscopic surgical approaches such as transoral robotic surgery (TORS), and the continued refinement of conformal radiotherapy techniques, have improved treatment options for patients with recurrent HPV + OPSCC. Systemic treatment options have continued to expand including potentially effective immune-based therapies. Effective surveillance with systemic and oral biomarkers offers hope of earlier detection of recurrence. Management of patients with recurrent OPSCC remains difficult. Modest improvements in salvage treatment have been observed within the HPV + OPSCC cohort largely reflecting disease biology and improved treatment techniques.

Risk of weathered residual Exxon Valdez oil to pink salmon embryos in Prince William Sound.

It has been hypothesized that pink salmon eggs incubating in intertidal streams transecting Prince William Sound (PWS) beaches oiled by the Exxon Valdez oil spill were exposed to lethal doses of dissolved hydrocarbons. Since polycyclic aromatic hydrocarbon (PAH) levels in the incubation gravel were too low to cause mortality, the allegation is that dissolved high-molecular-weight hydrocarbons (HPAH) leaching from oil deposits on the beach adjacent to the streams were the source of toxicity. To evaluate this hypothesis, we placed pink salmon eggs in PWS beach sediments containing residual oil from the Exxon Valdez oil spill and in control areas without oil. We quantified the hydrocarbon concentrations in the eggs after three weeks of incubation. Tissue PAH concentrations of eggs in oiled sediments were generally < 100 ppb and similar to background levels on nonoiled beaches. Even eggs in direct contact with oil in the sediment resulted in tissue PAH loads well below the lethal threshold concentrations established in laboratory bioassays, and very low concentrations of HPAH compounds were present. These results indicate that petroleum hydrocarbons dissolved from oil deposits on intertidal beaches are not at concentrations that pose toxic risk to incubating pink salmon eggs. The evidence does not support the hypothesis that interstitial pore water in previously oiled beaches is highly toxic.