Affiliations
Associate Professor;
Department of Otolaryngology,
Head and Neck Surgery
Baylor College of Medicine;
Staff Physician
Michael E. DeBakey VA Medical Center
Houston, Texas
Disclosures: Serve(d) as a director, of cer, partner,
employee, advisor, consultant, or trustee for: FemtoVox
Inc (Consultant; Equity holder); PDS Biotech (consultant).
Received income in an amount equal to or greater than
$250 from: FemtoVox Inc, PDS Biotech.

AI-Based Risk Stratification for Oropharyngeal Carcinomas: AIROC

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AI-Based Risk Stratification for Oropharyngeal Carcinomas: AIROC

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Vlad Sandulache, MD, PhD

Click here to view more from Cancer Data Trends 2025.

References

1.       Zevallos JP, Kramer JR, Sandulache VC, et al. National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System. Head Neck. 2021;43(1):108-115. doi:10.1002/hed.26465

2.       Fakhry C, Blackford AL, Neuner G, et al. Association of oral human papillomavirus DNA persistence with cancer progression after primary treatment for oral cavity and oropharyngeal squamous cell carcinoma. JAMA Oncol. 2019;5(7):985-992. doi:10.1001/jamaoncol.2019.0439

3.       Fakhry C, Zhang Q, Gillison ML, et al. Validation of NRG oncology/RTOG-0129 risk groups for HPV-positive and HPV-negative oropharyngeal squamous cell cancer: implications for risk-based therapeutic intensity trials. Cancer. 2019;125(12):2027-2038. doi:10.1002/cncr.32025

4.       O'Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol. 2016;17(4):440-451. doi:10.1016/S1470-2045(15)00560-4

5.       Koyuncu CF, Lu C, Bera K, et al. Computerized tumor multinucleation index (MuNI) is prognostic in p16+ oropharyngeal carcinoma. J Clin Invest. 2021;131(8):e145488. doi:10.1172/JCI145488

6.       Lu C, Lewis JS Jr, Dupont WD, Plummer WD Jr, Janowczyk A, Madabhushi A. An oral cavity squamous cell carcinoma quantitative histomorphometric-based image classifier of nuclear morphology can risk stratify patients for disease-specific survival. Mod Pathol. 2017;30(12):1655-1665. doi:10.1038/modpathol.2017.98

7.       Corredor G, Toro P, Koyuncu C, et al. An imaging biomarker of tumor-infiltrating lymphocytes to risk-stratify patients with HPV-associated oropharyngeal cancer. J Natl Cancer Inst. 2022;114(4):609-617. doi:10.1093/jnci/djab215

8.       Cancer stat facts: oral cavity and pharynx cancer. National Cancer Institute, SEER Program. Accessed November 5, 2024. https://seer.cancer.gov/statfacts/html/oralcav.html

9.       Cancers associated with human papillomavirus. Centers for Disease Control and Prevention. September 18, 2024. Accessed November 5, 2024. https://www.cdc.gov/united-states-cancer-statistics/publications/hpv-associated-cancers.html

10.      Chidambaram S, Chang SH, Sandulache VC, Mazul AL, Zevallos JP. Human papillomavirus vaccination prevalence and disproportionate cancer burden among US veterans. JAMA Oncol. 2023;9(5):712-714. doi:10.1001/jamaoncol.2022.7944

11.      Corredor G, Wang X, Zhou Y, et al. Spatial architecture and arrangement of tumor-infiltrating lymphocytes for predicting likelihood of recurrence in early-stage non-small cell lung cancer. Clin Cancer Res. 2019;25(5):1526-1534. doi:10.1158/1078-0432.CCR-18-2013

12.      Alilou M, Orooji M, Beig N, et al. Quantitative vessel tortuosity: a potential CT imaging biomarker for distinguishing lung granulomas from adenocarcinomas. Sci Rep. 2018;8(1):15290. doi:10.1038/s41598-018-33473-0

13.      Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. doi:10.3322/caac.21388

Author and Disclosure Information

Vlad C. Sandulache, MD, PhD
Associate Professor;
Department of Otolaryngology,
Head and Neck Surgery
Baylor College of Medicine;
Staff Physician
Michael E. DeBakey VA Medical Center
Houston, Texas
 

Disclosures: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: FemtoVox Inc (Consultant; Equity holder); PDS Biotech (consultant).
Received income in an amount equal to or greater than $250 from: FemtoVox Inc; PDS Biotech.

Publications
Federal Practitioner
Topics
Head & Neck/Thyroid Cancers
Oncology
Author(s)
Vlad Sandulache, MD, PhD
Author(s)
Vlad Sandulache, MD, PhD
Author and Disclosure Information

Vlad C. Sandulache, MD, PhD
Associate Professor;
Department of Otolaryngology,
Head and Neck Surgery
Baylor College of Medicine;
Staff Physician
Michael E. DeBakey VA Medical Center
Houston, Texas
 

Disclosures: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: FemtoVox Inc (Consultant; Equity holder); PDS Biotech (consultant).
Received income in an amount equal to or greater than $250 from: FemtoVox Inc; PDS Biotech.

Author and Disclosure Information

Vlad C. Sandulache, MD, PhD
Associate Professor;
Department of Otolaryngology,
Head and Neck Surgery
Baylor College of Medicine;
Staff Physician
Michael E. DeBakey VA Medical Center
Houston, Texas
 

Disclosures: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: FemtoVox Inc (Consultant; Equity holder); PDS Biotech (consultant).
Received income in an amount equal to or greater than $250 from: FemtoVox Inc; PDS Biotech.

Click here to view more from Cancer Data Trends 2025.

Click here to view more from Cancer Data Trends 2025.

References

1.       Zevallos JP, Kramer JR, Sandulache VC, et al. National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System. Head Neck. 2021;43(1):108-115. doi:10.1002/hed.26465

2.       Fakhry C, Blackford AL, Neuner G, et al. Association of oral human papillomavirus DNA persistence with cancer progression after primary treatment for oral cavity and oropharyngeal squamous cell carcinoma. JAMA Oncol. 2019;5(7):985-992. doi:10.1001/jamaoncol.2019.0439

3.       Fakhry C, Zhang Q, Gillison ML, et al. Validation of NRG oncology/RTOG-0129 risk groups for HPV-positive and HPV-negative oropharyngeal squamous cell cancer: implications for risk-based therapeutic intensity trials. Cancer. 2019;125(12):2027-2038. doi:10.1002/cncr.32025

4.       O'Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol. 2016;17(4):440-451. doi:10.1016/S1470-2045(15)00560-4

5.       Koyuncu CF, Lu C, Bera K, et al. Computerized tumor multinucleation index (MuNI) is prognostic in p16+ oropharyngeal carcinoma. J Clin Invest. 2021;131(8):e145488. doi:10.1172/JCI145488

6.       Lu C, Lewis JS Jr, Dupont WD, Plummer WD Jr, Janowczyk A, Madabhushi A. An oral cavity squamous cell carcinoma quantitative histomorphometric-based image classifier of nuclear morphology can risk stratify patients for disease-specific survival. Mod Pathol. 2017;30(12):1655-1665. doi:10.1038/modpathol.2017.98

7.       Corredor G, Toro P, Koyuncu C, et al. An imaging biomarker of tumor-infiltrating lymphocytes to risk-stratify patients with HPV-associated oropharyngeal cancer. J Natl Cancer Inst. 2022;114(4):609-617. doi:10.1093/jnci/djab215

8.       Cancer stat facts: oral cavity and pharynx cancer. National Cancer Institute, SEER Program. Accessed November 5, 2024. https://seer.cancer.gov/statfacts/html/oralcav.html

9.       Cancers associated with human papillomavirus. Centers for Disease Control and Prevention. September 18, 2024. Accessed November 5, 2024. https://www.cdc.gov/united-states-cancer-statistics/publications/hpv-associated-cancers.html

10.      Chidambaram S, Chang SH, Sandulache VC, Mazul AL, Zevallos JP. Human papillomavirus vaccination prevalence and disproportionate cancer burden among US veterans. JAMA Oncol. 2023;9(5):712-714. doi:10.1001/jamaoncol.2022.7944

11.      Corredor G, Wang X, Zhou Y, et al. Spatial architecture and arrangement of tumor-infiltrating lymphocytes for predicting likelihood of recurrence in early-stage non-small cell lung cancer. Clin Cancer Res. 2019;25(5):1526-1534. doi:10.1158/1078-0432.CCR-18-2013

12.      Alilou M, Orooji M, Beig N, et al. Quantitative vessel tortuosity: a potential CT imaging biomarker for distinguishing lung granulomas from adenocarcinomas. Sci Rep. 2018;8(1):15290. doi:10.1038/s41598-018-33473-0

13.      Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. doi:10.3322/caac.21388

References

1.       Zevallos JP, Kramer JR, Sandulache VC, et al. National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System. Head Neck. 2021;43(1):108-115. doi:10.1002/hed.26465

2.       Fakhry C, Blackford AL, Neuner G, et al. Association of oral human papillomavirus DNA persistence with cancer progression after primary treatment for oral cavity and oropharyngeal squamous cell carcinoma. JAMA Oncol. 2019;5(7):985-992. doi:10.1001/jamaoncol.2019.0439

3.       Fakhry C, Zhang Q, Gillison ML, et al. Validation of NRG oncology/RTOG-0129 risk groups for HPV-positive and HPV-negative oropharyngeal squamous cell cancer: implications for risk-based therapeutic intensity trials. Cancer. 2019;125(12):2027-2038. doi:10.1002/cncr.32025

4.       O'Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol. 2016;17(4):440-451. doi:10.1016/S1470-2045(15)00560-4

5.       Koyuncu CF, Lu C, Bera K, et al. Computerized tumor multinucleation index (MuNI) is prognostic in p16+ oropharyngeal carcinoma. J Clin Invest. 2021;131(8):e145488. doi:10.1172/JCI145488

6.       Lu C, Lewis JS Jr, Dupont WD, Plummer WD Jr, Janowczyk A, Madabhushi A. An oral cavity squamous cell carcinoma quantitative histomorphometric-based image classifier of nuclear morphology can risk stratify patients for disease-specific survival. Mod Pathol. 2017;30(12):1655-1665. doi:10.1038/modpathol.2017.98

7.       Corredor G, Toro P, Koyuncu C, et al. An imaging biomarker of tumor-infiltrating lymphocytes to risk-stratify patients with HPV-associated oropharyngeal cancer. J Natl Cancer Inst. 2022;114(4):609-617. doi:10.1093/jnci/djab215

8.       Cancer stat facts: oral cavity and pharynx cancer. National Cancer Institute, SEER Program. Accessed November 5, 2024. https://seer.cancer.gov/statfacts/html/oralcav.html

9.       Cancers associated with human papillomavirus. Centers for Disease Control and Prevention. September 18, 2024. Accessed November 5, 2024. https://www.cdc.gov/united-states-cancer-statistics/publications/hpv-associated-cancers.html

10.      Chidambaram S, Chang SH, Sandulache VC, Mazul AL, Zevallos JP. Human papillomavirus vaccination prevalence and disproportionate cancer burden among US veterans. JAMA Oncol. 2023;9(5):712-714. doi:10.1001/jamaoncol.2022.7944

11.      Corredor G, Wang X, Zhou Y, et al. Spatial architecture and arrangement of tumor-infiltrating lymphocytes for predicting likelihood of recurrence in early-stage non-small cell lung cancer. Clin Cancer Res. 2019;25(5):1526-1534. doi:10.1158/1078-0432.CCR-18-2013

12.      Alilou M, Orooji M, Beig N, et al. Quantitative vessel tortuosity: a potential CT imaging biomarker for distinguishing lung granulomas from adenocarcinomas. Sci Rep. 2018;8(1):15290. doi:10.1038/s41598-018-33473-0

13.      Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. doi:10.3322/caac.21388

Publications
Federal Practitioner
Publications
Federal Practitioner
Topics
Head & Neck/Thyroid Cancers
Oncology
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AI-Based Risk Stratification for Oropharyngeal Carcinomas: AIROC

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In recent years, human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has been on the rise in the veteran population, where smoking rates (a contributor to OPSCC development) have historically been higher than in the general population.1 Variable treatment response rates and survival in patients with OPSCC indicate that whereas some patients may benefit from treatment de-escalation and a concomitant reduction in treatment-related adverse effects, aggressive disease in a subset of patients mandates the use of rigorous chemoradiation treatments.2,3 At present, effective stratification systems identifying these patient subsets are lacking.4

To address this clinical gap, a team of VA clinicians and researchers is developing AIROC (an artificial intelligence [AI]-based risk stratification algorithm for oropharyngeal carcinomas).a AIROC is an AI and machine learning (ML)-based algorithm that may successfully stratify veterans with HPV-associated OPSCC into risk categories that can enable safer de-escalation or escalation of cancer treatments.5-7 By integrating AIROC into clinical practice, the VHA aims to personalize cancer treatment, improve patient outcomes, and establish a new standard of care for veterans with this deadly disease.
 

aThis work is funded by the Veterans Affairs Clinical Science Research and Development (CSRD) Service (grant I01BX006380).

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