Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer

Publication Date: April 25, 2019

Key Points

Key Points

  • The human papilloma virus has been identified as the etiologic agent in the majority of patients with squamous cell carcinoma of the oropharynx (tonsil and base of tongue) in North America and northern Europe.
    • Unlike tobacco-induced squamous cell cancer, which represents most cases of disease at other head and neck subsites, HPV-mediated OPC is increasing in frequency.
    • These cancers tend to occur in a younger, healthier population with less tobacco exposure.
    • Furthermore, the prognosis of HPV-mediated cancer is significantly better than that of the tobacco induced malignancies.
  • Historically, single modality surgery or radiation have been appropriate and highly effective treatment options for patients with stage I-II head and neck cancer.
    • Transoral surgical approaches and intensity modulated radiation have been rapidly incorporated into treatment standards and have proven very successful in limiting morbidity.
    • For more advanced disease, recent multimodality treatment standards used for oropharynx squamous cell cancer have generally employed concurrent cisplatin-based chemoradiotherapy, administered either definitely, or as a post-operative adjuvant. These treatments are rigorous and produce considerable acute and late toxicity.
  • In 2008 the National Cancer Institute concluded that ‚Äútreatment de-intensification‚ÄĚ was a reasonable investigational strategy to pursue in the HPV-mediated cancers with the best prognosis, with the goal of reducing short and long-term toxicity without compromising outcomes.

Recommendations

...Recommendations...

...ion of treatment intensity for p16+ OPC p...


Despite the identification of good-prognosis pa...


...d of care for the definitive non-operati...


...fication of treatment for patients with p16...