Onkológia 1/2020

De-escalation of chemoradiotherapy of oropharynx cancer associated with human papillomavirus

Intensive research in the new entity of squamous cell carcinomas of the head and neck (SCCHN) can be followed over last two decades. Specific biology, clinical presentation, prognosis and treatment response has been identified in oropharynx cancer associated with human papillomavirus (HPV+ OPC). High locoregional control of this malignancy after primary therapy is reflected in recently changed TNM classification. Substantial proportion of locoregionally advanced tumours is classified in stage I and II. High sensitivity of cancer cells to radiation, as well as good results of transoral surgical techniques, has provoked interest in de-intensification of primary treatment aiming at reduction of late toxicity. Several investigational strategies focus on patient selection for single modality approach or on optimal combination of multiple modalities. There is no data based on results of a randomised study supporting de-escalation of standard interventions in SCCHN. Treatment of HPV+ OPC with potential toxicity reduction can be offered only in a clinical study. A prospective multicenter study with de-escalated concomitant chemoradiotherapy has been initiated in Slovakia.

Keywords: HPV, oropharynx cancer, radiotherapy, chemotherapy