Oropharyngeal squamous cell carcinoma (OPSCC) includes cancers of the tonsils, base of tongue, soft palate, and upper lateral and posterior pharyngeal walls. In 2016, an estimated 48,330 patients are expected to be diagnosed with cancer of the oral cavity and pharynx in the United
States.1 Incidence rates are more than twice as high in men compared with women.2 Over the past few decades, a shift has occurred such that the incidence of human papillomavirus (HPV)–associated cancers of the oropharynx has increased, while the
incidence of HPV-negative tobacco-driven OPSCC has declined. HPV-positive patients with OPSCC tend to be more frequently male and younger and have a better performance status and prognosis. The options for curative management of OPSCC include surgery with or without
adjuvant radiotherapy (with concurrent chemotherapy in selected patients) and primary radiotherapy with or without concurrent systemic therapy. To provide guidance on the use of definitive or adjuvant radiation therapy for OPSCC, the American Society for Radiation Oncology (ASTRO) published evidence-based recommendations in Practical Radiation Oncology in July 2017. At this time, the evidence base is not sufficiently developed to allow different recommendations for radiation therapy for OPSCC according to HPV status; however, with continued accrual to clinical trials, it may be possible to make more specific recommendations in
the future.