[De-escalation concepts for chemoradiotherapy of HPV-positive oropharyngeal carcinomas: pros and cons].

BACKGROUND: In contrast to alcohol- and nicotine-induced head and neck tumors, human papillomavirus (HPV)-positive oropharyngeal carcinoma rather affects younger patients, and the incidence of this entity is continuously increasing. Due to the significantly better prognosis of HPV-positive oropharyngeal carcinoma, various treatment de-escalation strategies are currently being investigated, with the aim of reducing toxicity without affecting the good survival rates of these patients. OBJECTIVE: This study aims to evaluate the evidence for treatment de-escalation in HPV-positive oropharyngeal carcinoma. MATERIALS AND METHODS: A literature search was performed and relevant studies are critically discussed. RESULTS: De-escalation strategies for HPV-associated oropharyngeal carcinoma using induction chemotherapy or radiation dose reduction have demonstrated good oncological results in phase II trials, with lower toxicity rates compared to historical controls. However, both of the first published phase III trials investigating de-escalation of concomitant chemotherapy regimens demonstrated inferior outcomes for the deescalated treatment strategies without improvements in treatment-associated toxicities. Additional phase-III trials investigating other de-escalation strategies have not yet been published. CONCLUSION: Treatment de-escalation should be performed exclusively in prospective studies and can currently not be recommended in clinical routine.