Treatment De-escalation for Oropharyngeal Carcinoma in the Human Papillomavirus Era

Abstract

Treatment of human papillomavirus (HPV) oropharyngeal carcinomas requires a multidisciplinary approach as varied paradigms yield equally favorable oncologic outcomes. Adverse effects from the various treatment modalities can significantly affect quality of life differently and therefore have been important study endpoints in de-escalation trials. This presentation summarizes the management of oropharyngeal carcinomas and strategies to de-intensify treatment with a focus on the reduction of radiation dose. It will review the recent literature supporting the use of biomarkers including functional imaging, circulating HPV tumor DNA, and rapid mid-treatment nodal shrinkage to identify patients in which treatment can be safely de-escalated. Evidence suggests that there may be a group of patients that may benefit from de-escalation of treatment while maximally sparing organs at risk important for swallowing, speech, and salivary flow.