Strategii de dezescaladare ale tratamentului oncologic pentru cancerul de orofaringe HPV-pozitiv.

HPV-positive oropharynx cancers have an increasing incidence in the last two decades, especially among young nonsmoking adults. Retrospective studies have shown that the prognosis of these cancers is superior than in those HPV negative. The multivariate analysis of prognosis taking into account the HPV status and the TNM staging has led to a new staging system for these particular cancers, published in the 8th AJCC manual. The combined treatment, such as radiochemotherapy or surgery followed by adjuvant radiotherapy, causes serious acute and late toxicities, like mucositis, dysphagia, xerostomia and cervical fibrosis. Given the young age group and the better prognosis of HPVpositive cancers, a series of new strategies to deintensify the treatment have been introduced, such as lower total dose of radiotherapy, omitting chemotherapy or replacing some cytotoxic agents with other less toxic. This paper presents the standard treatment for HPV-positive cancers and a summary of published or still pending studies for deescaladation. We also list the common late toxicities with an impact on the quality of life. [ABSTRACT FROM AUTHOR]