Unfortunately, these patients are subject to the side effects of surgical procedures as well as those of nonsurgical interventions [9,31]. neck malignancy [32,34,45]. In addition, an increased risk for tongue and tonsil carcinomas are observed in male partners of women with cervical carcinoma [2,10,32,46], and these results have been corroborated by a match around the HPV type in those couples [29,34,47,48]. Therefore, significant accumulated evidence supports the idea that the likely transmission of this infection is primarily through oralCgenital and oralCoral routes [26,34]. Since HPV-positive oropharyngeal cancers display a different etiology than do HPV-negative cancers [14,21,49], HPV-derived OPSCCs are found in a subpopulation of patients that is epidemiologically, genetically, and demographically unique from patients presenting with the more traditional HPV-negative OPSCCs [2,9,11,22]. Unlike HPV-negative OPSCCs, which are typically found in individuals older than 60 years of age with a strong history of tobacco and alcohol consumption [11,50], HPV-related OPSCC typically appears in more youthful populations, between the ages of 40 and 55, with generally low GSK1904529A levels of substance abuse [9,12,29,37,51]. This cohort of patients tends to be high functioning , and demonstrates a better general condition  as well as health [2,3,36,39,52,53,54,55]. Moreover, a recent study reported an 80% higher incidence in males than in females [2,11,19,25,32,56,57] and a lower incidence in blacks than in Caucasians (4% in blacks 34% in their Caucasian counterparts) [2,21,32,58,59]. In addition, this patient cohort possesses higher economic status and more education [2,13]. Therefore, subjects GSK1904529A with HPV-related HNSCC are likely to be middle-aged Caucasian males who are non-smokers and non-drinkers with a higher socioeconomic status and educational level [9,28,32]. 3. Current Treatments and Therapies Current therapeutic interventions for HNSCC patients include medical procedures, chemotherapy, and radiotherapy Rabbit Polyclonal to p50 Dynamitin [6,15,52,60]. Each of these treatments have been employed at different clinics in the US , but currently no clinical guidelines differentiating treatment strategies between HPV-derived and tobacco-derived HNSCC exist [23,61,62]. Moreover, only a few clinical trials have made such a variation [1,2,31,60,63,64,65,66], even though these two subsets represent individual disease entities pathologically and etiologically [24,26,31,49,57,63]. Presently, the standard therapy for head and neck malignancy is determined by the tumor stage [2,4,15,64], the site of the tumor [4,15,64] and the expected functional outcomes , as well as by the preference of the practitioner and the patient, which include considerations of the level of organ preservation and the patients quality of life . Head and neck cancer is classified into the following groups: early-stage or stage I/II, locally advanced or stage III/IV, and recurrent or metastatic phase . Early stages of head and neck malignancy are usually treated with a single-modality treatment, such as radiotherapy or surgical resection [4,12,13,15,68]. A combination of multiple therapies for superior oncologic GSK1904529A results are required for the management of advanced stages III/IV [4,61,67]; for example, medical procedures with adjuvant radiation or chemoradiation with chemotherapy being added for high risk pathologic features found from the surgical specimen [2,14,35,69,70], or radiotherapy with concomitant chemotherapy [14,64,71,72,73]. Therefore, patients with advanced stages of head and neck malignancy are treated through a multidisciplinary and multimodal treatment approach [50,67,68,74]. 3.1. Surgery Surgery is one of the standard treatments for early stage I/II HNSCC. In the past, surgical procedures sometimes consisted of considerable open transmandibular, and open pharyngotomy procedures [2,12,62,64,75] that resulted in severe morbidities including facial deformity, dysarthria, and dysphagia [15,52,53,62], especially in more locally advanced cases. Over the past 30 years, improvements in radiotherapy and chemotherapy yielding favorable oncologic outcomes shifted treatment choices away from open medical procedures [52,55,62], until new minimally invasive GSK1904529A trans-oral surgery (TOS) came into prominence as a viable surgical tool for early phase OPSCC [9,54,62,66,75] within the last decade, encouraging to reduce morbidity and mortality while improving organ preservation [9,24,53]. This new surgical approach enables resection of a tumor through the opening of the mouth without the damage to normal tissue and musculature seen in transcervical or transmandibular methods [62,76]. Because of these developments in technology, HPV-associated OPSCC patients may be the most appropriate subgroup to undergo a minimally invasive TOS regimen since they tend to be younger, GSK1904529A nonsmokers, and have good odds for long-term survival [9,62]. Moreover, the restoration of surgical resection as.