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 Center.

Data 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. These recommendations are based on the American Joint Committee on Cancer seventh edition TNM Staging System and applicable only to patients who receive concurrent platinum-based chemotherapy and in whom both p16 immunohistochemistry and human papillomavirus RNA in situ hybridization tests are positive.