Precision Radiotherapy for HPV-Associated Oropharyngeal Carcinoma: Evolving Approaches to Dose and Volume De-intensification.

Abstract

This review discusses the current efforts to de-intensify radiotherapy in human papillomavirus -positive oropharyngeal cancer to reduce long-term toxicity without compromising tumor control. It explores strategies, such as reducing dose and volume, selective omission of elective nodal irradiation, and tailoring treatment based on tumor response and patient risk profiles. Emerging evidence from clinical trials supports the safety and efficacy of lower radiation doses and smaller treatment volumes in selected patients. Advanced imaging and precise targeting may allow for smaller margins, further minimizing damage to the surrounding healthy tissue. None of these approaches have yet replaced the current standard of care.