Jacobs Journal of Radiation Oncology

A Case of HPV-positive Oropharyngeal Cancer with Second Primary Tumor – Implications for Treatment and Follow-up

Published on: 2018-11-19


Over the past 15 years, human papillomavirus (HPV) has become a well-known etiologic factor in the development of squamous cell carcinoma of the head and neck, particularly of the oropharynx. Although current guidelines do not identify HPV-positivity as a factor to consider in determining treatment deintensification, recognition of HPV-positive squamous cell carcinomas as a distinct clinical entity with less risk for second primary tumors raises the question of the appropriateness of ipsilateral definitive surgery or radiotherapy in HPV-positive patients. We report the case of a man with an HPV-positive oropharyngeal SCC treated with definitive ipsilateral radiation who later developed a contralateral metachronous second primary tumor. This second primary tumor was treated with a neck dissection followed by adjuvant ipsilateral radiation and concurrent chemotherapy. This case demonstrates the importance of considering the phenomenon of second primary tumors in patients with HPV-positive head and neck squamous cell carcinoma and illustrates the utility of advanced radiation technologies in creating treatment plans allowing for minimal overlap if a contralateral treatment becomes necessary. In addition, as publications regarding this phenomenon are limited, this case also highlights the need for greater understanding of the etiology, pathogenesis, clinical behavior, and prognosis of second primary tumors in HPV-positive patients. We anticipate this will become an increasingly recognized phenomenon and clinical scenario for the modern-day radiation oncologist.


Squamous Cell Carcinoma; Human Papillomavirus; Oropharynx; Radiation; Second Primary Tumor