pairingsPairing
Caution: de-escalating radiation on HPV status alone
Being HPV-positive is not enough to justify less radiation; trials that tried it saw more relapses.
NRG-HN005 (60 Gy arms) and cetuximab-substitution trials (RTOG 1016, De-ESCALaTE) all underperformed standard cisplatin chemoradiation. Response-adapted or ctHPV-DNA-guided selection is the current approach.
Rationale
HPV-positive tumours are heterogeneous in smoking exposure, nodal burden, and biology; a single marker over-selects.
Evidence
Multiple randomised trials.