In recent years, cases of HPV-positive oropharyngeal carcinomas (HPVOPCs) have continued to increase throughout world. In many cases, radiotherapy is conducted as HPVOPCs are considered to be more radiosensitive than HPV-negative tumors. However, smoking affects the radiosensitivity of HPVOPCs which typically results in a poorer prognosis than can be expected when treating HPVOPCs associated with non-smokers. Prior to radiotherapy, it is critical that patients HPV status, neck metastasis, and history of tobacco use are examined carefully.
In regard to locoregionally advanced OPC (T3-4, N2-3, Mx), the optimal treatment is considered to be concurrent chemoradiotherapy. Multiple studies have reported that concurrent chemoradiotherapy improves locoregional control and overall survival in patients with locoregionally advanced head and neck cancer. However, significant acute and late toxicities of concurrent chemoradiotherapy have been recorded in up to 29% of survivors. Consequently, patients require gastrostomy tubes and there have been unexplained cases of late mortality. As a result, clinical trials examining deintensification treatment are currently investigating new strategies to improve patient prognosis associated with HPVOPC. However, regional relapses of advanced OPC were significantly poor prognosis. It is imperative that the indication of deintensification treatment for OPCs be carefully considered due to the current low salvage rate.