A review of combined treatment strategies for HPV(+), p16(+) oropharyngeal cancer – is de-escalated radiotherapy a convincing and promising paradigm?

Abstract

Biological and clinical interest on HPV-associated oropharyngeal cancer (OPC) is rapidly increasing. The genetic and biological characteristics of HPV and p16 expression are presented. The significantly better prognosis (overall survival, locoregional control) of HPV p16(+) OPC patients has been well documented. The leading studies and clinical trials in this field are selected and discussed in details. There is a convincing suggestion that some, low-risk HPV(+) OPC patients might be overtreated. Different approaches with varying degrees of radiotherapy dose de-intensification are critically reviewed and the current de-escalated treatment paradigms are presented and discussed.