title: Optimizing Radiotherapy in HPV-Associated Oropharyngeal Cancer Patients.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands. j.a.langendijk@rt.umcg.nl.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.affiliation: University of Groningen, Groningen, The Netherlands.
authors.forename: Roel J H M
authors.initials: RJ
authors.lastname: Steenbakkers
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000379:methods; D006801:Humans; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000821:virology*; D061766:Proton Therapy / Q000379:methods; D011879:Radiotherapy Dosage
keywords: Cetuximab; Chemoradiation; De-escalation; HPV-positive OPC; Proton therapy; Radiotherapy; Toxicity