title: Should We De-escalate the Treatment for HPV-Positive Tumors?
abstract: De-escalation or de-intensification of therapy is discussed since many retrospective analyses of former trials demonstrated significantly better outcome for patients suffering from p16/HPV16-positive oropharyngeal squamous cell carcinoma of head and neck (OHNSCC). These observations are comprehensively addressed, but the reader has to keep in mind that none of the currently discussed data result from prospective controlled trials addressing the HPV-discrimination in the primary endpoint design. Identification of the true HPV16-related tumors is still challenging and in addition with different clinical reports and lack of data of prospective trials not mature for routine clinical decision making in 2016. Independent of the currently lacking evidence for HPV-dependent treatment de-escalation, there are some relevant arguments to address this question in ongoing and future trials.
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany. Andreas.Dietz@medizin.uni-leipzig.de.|Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany. Andreas.Dietz@medizin.uni-leipzig.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Dietz
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany.|Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Wichmann
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany.|Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Wiegand
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy* / Q000821:virology*; D006801:Humans; D009959:Oropharyngeal Neoplasms / Q000628:therapy* / Q000821:virology*; D027383:Papillomaviridae / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000628:therapy* / Q000821:virology; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: De-escalation; De-intensification; Functional outcome; HPV-related treatment stratification; Late toxicity; Quality of life (QoL); Survival; Transoral surgery