Prevention of recurrence of oral hpv-related lesions: systematic review of the literature and meta-analysis

(1) Background The incidence of oral cavity lesions related to human papillomavirus (HPV) is 3%. There are no reliable data in the literature on recurrence rates of HPV-related oral cavity lesions. The only data available concern gynecological infections, which have a recurrence rate of ~30%. Recurrence may be due to a failure to completely eradicate the lesion, persistence of the viral infection, or persistence of an immune-compromised state. Therefore, the study aimed to ascertain the most effective therapeutic strategy to achieve complete eradication of the virus and avoid a possible recurrence of lesions, based upon the long-term behavior of the virus with the type of treatment. (2) Methods: Systematic searches of the Cochrane Library, EMBASE, Pubmed, Web of Science, clinicaltrials.gov, and SCOPUS were performed. Restrictions were placed on the date of publication and language. Only English or Italian language articles published between Jan 1990 and Dec 2019 were included in the meta-analysis. The following keywords and/or corresponding medical subject heading terms were used: “oral papillomavirus lesions” and “oral HPV lesions” or “treatment”, “therapy”, “therapeutics,” and “management”. (3) Results: Upon systematic literature review of all analyzed HPV-lesion treatment techniques, 36 studies on laser and cold scalpel eradications were selected. These studies document an excellent success rate from excisional treatments using both laser and cold scalpel and report low recurrence rates with both techniques, respectively 5.98% and 4.07%. (4) Conclusions: The meta-analysis revealed that additional studies with greater sample sizes are needed for these two treatment methods. It would also be appropriate to carry out case-controlled studies, preferably RCTs, to determine the best treatment for eradicating HPV-related lesions.