Debate: Accepted strategies for de-intensification in low risk HPV related oropharyngeal squamous cell carcinoma (OPSCC)

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Debate: Accepted strategies for de-intensification in low risk HPV related oropharyngeal squamous cell carcinoma (OPSCC)

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The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased, despite decreasing rates of smoking and alcohol consumption which used to be primary risk factors.1-4 This increase in OPSCC can be attributed to HPV oral infections, which has created a new, clinically distinctive form of OPSCC.1 Fortunately, patients with HPV-positive OPSCC are typically younger in age and have better prognoses than their HPV-negative counterparts.1-4 A meta-analysis of 720 confirmed that patients with HPV-positive OPSCC have a 58% reduction in mortality, as compared to patients who are HPV-negative.2 Because the standard of care for OPSCC used to be based on older clinical trials, primarily patients who were HPV-negative, there are multiple ongoing trials that are attempting de-escalated treatment. Patients who are HPV-positive, have lower T and N disease stages, and a minimal smoking history represent a low-risk case and may not require the same intensity of chemotherapy, radiotherapy, and surgical treatment. More intense treatment may just increase the short and long term toxicity and diminish patients' quality of life unnecessarily.3

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