Dose de-escalation in head and neck cancer treatment

A review of the efficacy of radiotherapy and chemotherapy dose de-escalation in human papillomavirus-positive oropharyngeal cancers

Published on June 1, 2025

Head and neck carcinomas (HNC) originate in the upper aerodigestive tract, including the nasopharynx, sinuses, oral cavity, oropharynx, hypopharynx, larynx and salivary glands1. The main histological type is squamous cell carcinoma (HNSCC) with a global incidence of around 890,000 new cases annually, representing 4.5% of cancer diagnoses2. The major risk factors for developing an HNSCC include tobacco use and heavy prolonged alcohol use, and there is traditionally a male predominance2, 3, 4. However human papillomavirus (HPV) 16 and, more rarely, 18 infection is now surpassing tobacco and alcohol as the predominant aetiological factor in developed nations in cancers of the oropharyngeal region1, 2, 5. HPV-positive oropharyngeal squamous cell carcinomas (OPSCC) are epidemiologically distinct compared with HPV negative presentations, characterised by younger age at onset and the cancer is thought to develop 10 to...

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