Abstract
Increasing number of patients with head and neck cancer has been treated with chemoradiation therapy, as organ preservation therapy, rather than surgery. However, acute and late toxicity from chemoradiation often cause poor quality of life. The human papillomavirus (HPV) has been identified as the causative agent of a growing subset of oropharyngeal cancer (OPC). Recent studies have demonstrated that the HPV status determines the prognosis of oropharyngeal cancer. The Survival rate of HPV positive OPC treated with chemoradiation have been reported to be as high as 80-90%. Based on these results, some groups are evaluating whether similar good response could be achieved with de-escalation treatment. The strategies for de-escalation are dose reduction of chemoradiation or bioradiation with anti-EGFR antibodies. On the other hand, it has been demonstrated that patients with HPV positive OPC treated with conventional radiotherapy alone can achieve good treatment response. This result prompted us to conduct the clinical trial in which patients with HPV positive OPC receive 70 Gy of intensity modulated radiotherapy. The tailor made therapy for OPC based on its HPV status is now under investigation. Good prognosis as well as better functional outcome can be achieved by the de-escalation strategy in the near future.
