110 HPV-Positive Oropharyngeal Cancer: A Review of De-Escalation Strategies Used to Improve Outcomes for This Patient Cohort

Abstract Aim Human Papillomavirus (HPV) positive oropharyngeal cancer (OPC) has been shown to provide improved survival compared to HPV negative patients with similar disease. This has led to a new staging criteria for these patients and attempts to de-escalate treatment for this group, to maintain high survival and reduce associated side effects. This review aims to assess current research into treatment techniques and compare results of these studies. Method Pubmed online database was used to gather studies containing primary research dated from within the last 10 years detailing the study design, the striation of patients into higher and lower risk groups, and the outcome of de-escalation of treatment to these groups. Results Published studies vary in their definition of their ‘low risk’ group, however minimal smoking history, smaller tumour size and increased HPV DNA expression within the tumour are all identified as good prognostic indicators and could be and have been used to identify suitable candidates for treatment deintensification. The combination of radiotherapy and chemotherapy are often used with good success however, no consensus has been reached regarding dosing of these. Transoral robotic surgery may also be used in conjunction with chemoradiotherapy, however large ongoing studies regarding this are yet to publish their final results. Conclusions This is an evolving area of oncology with an increasing evidence base improving prognosis and minimising side effects for this group of patients, however more research is necessary to gain consensus on the gold standard treatment for these patients.