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Video

Head and Neck Surgery

(A657) Viral Load Surveillance and Disease Recurrence in HPV-Positive Oropharyngeal Cancer: A Systematic Review and Meta-Analysis

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • AT

    Annie R. Thornton, MD

    Resident
    United States Army, Walter Reed National Military Medical Center, Bethesda, MD
    Bethesda, MD, United States

    • Co-Author(s)

  • Claire Sturek, BBE, MD

    Intern
    Transitional Year Intern, Walter Reed National Military Medical Center, United States Navy
    Vienna , Virginia, United States

    • Co-Author(s)

  • Sarah Carr, BS

    Medical Student
    United States Navy, School of Medicine, Uniformed Services University, Bethesda, MD
    Chevy Chase, Maryland, United States

  • SR

    Sorana Raiciulescu, MSc

    Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, MD, United States

    • Senior Author(s)

  • MO

    Michael I. Orestes, MD

    Associate Professor Surgery, Director for Education, Training and Research
    United States Army, Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD
    Bethesda, Maryland, United States

Disclosure(s):
Claire Zelna, BBE, MD: No relevant relationships to disclose.
Sarah Carr, BS: No relevant relationships to disclose.
Michael I. Orestes, MD: No relevant relationships to disclose.


Introduction: HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) demonstrates better treatment responses than HPV-negative variants, yet recurrence rates can reach 20%, underscoring the need for effective post-treatment surveillance. Serum circulating tumor DNA (ctDNA) is a simple lab test for assessing disease presence. This systematic review and meta-analysis evaluates the evidence for ctDNA as a biomarker in HPV (+) OPSCC in the context of post-treatment surveillance.

Methods: A systematic review was conducted in August of 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles were excluded if they focused on HPV (-) OPSCC, lacked pre- and post-treatment viral load data, or were greater than 20 years old. All primary literature was considered. Treatment modalities encompassed any combination of surgery, chemotherapy, or radiation with curative intent. The primary outcome measure was disease recurrence. Data extraction and quality assessment were performed by three independent assessors and rated using the Oxford Centre for Evidence-based Medicine guidelines and Newcastle-Ottawa Scale criteria.

Results: The literature search identified 338 articles in PubMed. A total of 34 full texts were screened and 18 primary sources were included in the meta-analysis, providing a total pool of 2,857 patients. The overall prevalence of ctDNA after completion of curative treatment was 13.93% (95% CI [9.2; 20.46]). Patients with ctDNA had 78.8 times higher odds of recurrence (95% CI [26.18; 236.91]) than those who remained negative for ctDNA. Additional metrics, such as subgroup analysis per treatment modality, pooled sensitivity and specificity, positive and negative predictive values, and odds ratios, are currently being calculated.

Conclusions: The use of ctDNA as a biomarker may enable early and accurate detection of HPV (+) OPSCC disease recurrence. Standardization of study methods and protocols will further establish ctDNA’s utility in clinical practice and may lead to quantitative screening thresholds that reliably signal recurrence.