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Recent Results Cancer Res. 2017;206:161-171.

Optimizing Radiotherapy in HPV-Associated Oropharyngeal Cancer Patients.

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Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands.
University of Groningen, Groningen, The Netherlands.


Concurrent chemoradiation is considered the golden standard in the treatment of locally advanced OPC. However, given the very high survival rates in favorable HPV-positive OPC and the high rates of acute and late treatment-related side effects, de-escalation strategies have to be considered. In this chapter, the potential benefit of a number of de-escalation strategies is described, including of replacement of concurrent chemotherapy by cetuximab, radiation dose de-escalation based on response to induction chemotherapy, radiotherapy alone without systemic treatment, and limiting elective nodal target volumes for radiation. In addition to de-escalation, modern radiation technologies like protons will offer increasing opportunities to decrease the dose to normal tissues in order to prevent radiation-induced toxicities. Initial analysis showed that radiation dose de-escalation based on response to induction chemotherapy in combination with intensity-modulated proton therapy (IMPT) has the highest potential to decrease acute and late toxicities.


Cetuximab; Chemoradiation; De-escalation; HPV-positive OPC; Proton therapy; Radiotherapy; Toxicity

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