"The optimal treatment for a patient with HPV-positive oropharyngeal cancer involves collaboration between radiation oncologists, surgeons, medical oncologists and other specialists. This guideline highlights the necessity of a multidisciplinary approach to ensure that each patient receives a comprehensive, personalized treatment plan,” said David J. Sher, MD, MPH, chair of the guideline task force and a radiation oncologist at the University of Texas Southwestern Medical Center in Dallas. “By working together, we can provide the highest quality care that aligns with the patient's unique needs and preferences, ultimately improving their quality of life and treatment outcomes."
Full recommendations and supporting evidence are provided in the guideline; key recommendations are as follows. The expert task force also summarized their recommendations in treatment algorithms for definitive radiation/chemoradiation therapy (Figure 1) and for postoperative radiation/chemoradiation (Figure 2).
For patients treated for HPV+ OPSCC with definitive radiation therapy — that is, curative-intent radiation without surgery — concurrent systemic therapy is recommended if the patient has certain indicators of higher risk, such as more advanced tumor stage or the involvement of multiple lymph nodes. The guideline also outlines criteria where radiation alone is recommended over chemoradiation.
For patients treated with curative-intent surgery, postoperative radiation or chemoradiation therapy is recommended over observation if pathologic risk factors such as a positive surgical margin or certain tumor characteristics are present. The guideline discusses patient selection in detail and provides direction for the dosing and scheduling of postoperative radiation and chemoradiation.
Considerations for systemic therapy, including recommendations for chemotherapy drugs, dosing and sequencing with radiation therapy, also are outlined in the guideline, with an emphasis on shared decision making between physicians and patients that weighs the potential benefits and risks of treatment.
The guideline recommends optimal dosing and fractionation regimens for radiation and chemoradiation therapy in the definitive and postoperative settings. Taking into consideration data from recent dose de-escalation trials, the guideline recommends minimizing, when possible, doses to areas that most impact the patient’s quality of life, such as the organs responsible for swallowing and saliva production. Recommendations also address preferred radiation therapy techniques including intensity-modulated radiation therapy (IMRT).
