Radiation Dose De-Escalation in HPV-Positive Oropharynx Cancer: When Will It Be an Acceptable Standard of Care?

Human papillomavirus (HPV) is now the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) in the United States, with recent data suggesting that for every two new HPV-negative diagnoses of OPSCC, there are five new HPV-positive ones. 1 Observational studies and subset analyses of several prospective trials have demonstrated that patients with HPV-positive OPSCC present at a younger age and have a better overall prognosis when compared with HPV-negative patients. 2,3Although definitive chemoradiation therapy (CRT) for HPVpositive OPSCC is often curative, the resultant acute and long-term toxicity can significantly affect patients' quality of life. 4As such, there is now a strong push toward treatment de-escalation or deintensification for these patients, with the goal of reducing toxicity without affecting cure rates.