Abstract
Background: Studies on de-escalation in radiation therapy (RT) for human papillomavirus-related [HPV(+)] oropharyngeal cancer (OPC) are currently ongoing. This study investigated the current practice regarding the radiation dose and field in the treatment of HPV(+) OPC.Methods: The subcommittee on Oropharyngeal Cancer Treatment Guidelines of the Korean Society for Head and Neck Oncology (KSHNO) conducted a questionnaire on the primary treatment policy in five scenarios. Among them, for HPV(+) OPC scenarios, radiation oncologists were questioned regarding the field and dose of RT.Results: Forty-two radiation oncologists responded to the survey. In definitive concurrent chemoradiotherapy (CCRT) treatment for stage T2N1M0 OPC, most respondents prescribed a dose of >60 Gy to the primary tonsil and involved ipsilateral lymph nodes (LNs). However, eight of the respondents prescribed a relatively low dose of ≤54 Gy. Various doses were prescribed for the non-involved chain, and 50 and 54 Gy were the most commonly selected doses. For stage T2N1M0 OPC, postoperative adjuvant RT was prescribed by eight and nine respondents with a lower dose of ≤50 Gy for the ipsilateral tonsil and involved neck, respectively. In definitive CCRT in complete remission after induction chemotherapy for initial stage T2N3M0 OPC, most respondents included the contralateral LNs with less de-escalated radiation fields. De-escalation of the tonsil and involved neck were performed by eight and seven respondents, respectively. Regarding whether de-escalation is applied in radiotherapy for HPV(+) OPC, 27 (64.3%) did not do it at present, and 15 (35.7%) were doing or considering it.Conclusions: The field and dose of prescribed treatment varied between institutions in Korea. Among them, dose de-escalation of RT in HPV(+) OPC was observed in approximately 20% of the respondents. Consensus guidelines will be set in the near future after the completion of ongoing prospective trials.
Survey of Radiation Field and Dose in HPV-Positive Oropharyngeal Cancer: Is De-escalation Actually Applied in Clinical Practice?
