Treatment deintensification strategies for HPV-associated head and neck carcinomas.

Past treatment efforts for head and neck squamous cell carcinomas have emphasized treatment intensification that increased local-regional control rates with an increased risk of late (swallowing) complications. With the improved survival demonstrated for human papillomavirus-related oropharyngeal carcinomas, strategies offering comparable outcomes but with fewer complications are needed. Radiotherapy dose reduction has been postulated to reduce the risk of late complications and is an active area of investigation. Alternative strategies may include the use of transoral surgery offering selective use of adjuvant therapy. This article summarizes the contributing risk factors of late swallowing complications and the strategies for risk reduction.