Onkológia 6/2025
Trends in the treatment of HPV+ oropharyngeal cancer in Slovakia
Objective: The optimal management of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is a topic of an ongoing clinical research. This non-interventional study evaluated the current treatment trends in the treatment of HPV-positive (HPV+) OPC in Slovakia, with an emphasis on the incorporation of the treatment de-intensification into the routine clinical practice outside of the clinical trials.
Materials and Methods: The Slovak Cooperative Group for Head and Neck Cancer (SCGHNC) distributed a questionnaire to all radiation oncology (RO) facilities in Slovakia. Besides general information on the institution, respondents were asked to outline their management strategies in four theoretical HPV+ OPC case-reports, focusing on the applied dose of radiation therapy (RT), target volume delineation, and type of concomitant chemotherapy (CHT).
Results: Thirty-five RO specialists from 14/15 institutions participated in this study. In the case of primary chemoradiotherapy (CRT) in T1N1M0 HPV+ OPC, 16 respondents (46%) would consider RT dose deescalation <70 Gy. In the postoperative setting (pT1pN1M0, negative resection margins, no extracapsular extension), 4 respondents (11%) would deescalate the dose of RT to the tumor bed <60 Gy, while 19 (54%) would omit CHT. In the case of primary RT in an elderly comorbid patient T2N1M0, 14 respondents (40%) would deescalate the dose of RT and 14 (40%) would omit CHT. In the case of a high-risk patient (T2N3M0) with a complete response following induction chemotherapy, nearly all respondents (97%) would prescribe a standard dose of RT without dose de-escalation. In the routine clinical practice, primary RT dose deescalation <70 Gy in HPV+ OPC was reported by 16 respondents (46%) from 7 institutions; reduced concurrent CHT dose in primary or adjuvant clinical setting was reported by 13 (37%) from 4 institutions.
Conclusion: The treatment of HPV+ OPC in Slovakia varies significantly across the institutions. Dose deescalation of RT and omission of concomitant CHT are frequently considered in low-risk patients, along with the reduction of RT treatment fields, such as omission of contralateral neck. Personalization of therapy is ongoing, and consensus recommendations are anticipated pending results from prospective randomized trials.
Keywords: oropharyngeal cancer, human papillomavirus, radiotherapy, chemotherapy, treatment deintensification, deescalation of chemoradiotherapy
