Is It Necessary to Test Oropharyngeal Cancer for Both p16 and Human Papillomavirus?

Abstract

Tsai et al 1 Tsai C. McBride S. Riaz N. et al. Reducing the radiotherapy dose prescription for elective treatment areas in human papillomavirus (HPV)–associated oropharyngeal carcinoma (OPC) being treated with primary chemoradiotherapy at the Memorial Sloan Kettering Cancer Center. Pract Radiat Oncol. 2019; 9: 98-101 Abstract Full Text Full Text PDF Scopus (19) Google Scholar present their off-study program of low-dose elective nodal irradiation for human papillomavirus (HPV)–associated oropharyngeal carcinoma treated with primary chemoradiotherapy. One of the inclusion criteria is that tumor tissue is positive by both p16 immunohistochemistry (IHC) and HPV RNA in situ hybridization. This policy implies that it is important to do both tests because a patient who is p16 positive but HPV negative should be treated differently than a patient for whom both tests are positive. Many clinicians struggle with this question because direct HPV testing is neither done routinely at many facilities nor covered by many insurance programs. The purpose of this commentary is to review published data on the subject. Reducing the Radiation Therapy Dose Prescription for Elective Treatment Areas in Human Papillomavirus–Associated Oropharyngeal Carcinoma Being Treated With Primary Chemoradiotherapy at Memorial Sloan Kettering Cancer CenterPractical Radiation OncologyVol. 9Issue 2PreviewData on the biology and radiosensitivity of human papillomavirus–related cancers have led many expert radiation oncologists to decrease the radiation dose to target areas in selected situations. At Memorial Sloan Kettering Cancer Center, we have altered our radiation guidelines to allow substantial dose reduction to elective treatment regions and to omit radiation completely in other regions that have historically been included in the elective treatment volume. Here we summarize our current dose prescriptions and briefly explain the rationale behind these choices, which we anticipate will change when additional data mature. Full-Text PDF Throwing Down the Gauntlet Regarding Lowering the Elective Nodal Irradiation Dose in HPV-Associated Oropharyngeal CancerPractical Radiation OncologyVol. 9Issue 2PreviewIn medieval times, a knight would throw down a metal glove—called a gauntlet—as a challenge to combat. Our radiation oncology colleagues from Memorial Sloan Kettering Cancer Center (MSKCC) describe their program of low-dose elective nodal irradiation (ENI) as an educational service, but what they are doing is so different from historic practice that it challenges all of us to decide if we are going to make similar changes.1 Full-Text PDF