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Invited Commentary
November 2018

Gene Expression Profiling in HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas: A Path to Deintensification?

Author Affiliations
  • 1Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
JAMA Otolaryngol Head Neck Surg. 2018;144(11):976-977. doi:10.1001/jamaoto.2018.0774

Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is associated with p16 overexpression1 and a better prognosis than HPV-negative OPSCC.2 Concurrent treatment with standard-dose radiation therapy (RT) (66-70 Gy) and platinum-based chemotherapy is highly effective for most patients with p16-positive OPSCC, but more than 40% of patients experience severe late toxic effects when treated with concurrent chemoradiation therapy (CRT).3 The advent of transoral minimally invasive surgical approaches to the oropharynx, such as transoral robotic surgery (TORS) and transoral laser microsurgery (TLM), has provided an opportunity to treat patients with OPSCC while potentially minimizing long term sequelae of CRT. Treatment choice (ie, surgery with or without adjuvant therapy vs primary RT-CRT) and deintensification are areas of current investigation. However, given heterogeneity among patients with p16-positive OPSCC, optimal treatment paradigms remain unclear.

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