A 45-year-old with HPV-positive (p16+) oropharyngeal squamous cell carcinoma T2N2bM0 undergoes definitive chemoradiation. Compared to HPV-negative oropharyngeal carcinoma at the same stage, which statement is CORRECT?
- A 5-year overall survival exceeds 80% and de-escalation trials are ongoing ✓
- B Prognosis is worse due to rapid lymph node spread
- C Total laryngectomy is mandatory for cure
- D Cetuximab is superior to cisplatin for this HPV-positive subgroup
Correct answer: A. 5-year overall survival exceeds 80% and de-escalation trials are ongoing
Explanation
HPV-positive oropharyngeal SCC (defined by p16 overexpression as a surrogate marker) has a markedly better prognosis than HPV-negative disease — 5-year overall survival exceeds 80% with standard chemoradiation. This has prompted multiple de-escalation trials (NRG HN002, ECOG-ACRIN 3311) exploring reduced radiation dose and omission of chemotherapy to reduce treatment toxicity. Cetuximab has not been shown superior to cisplatin in the HPV-positive group (RTOG 1016 showed inferior outcomes with cetuximab).
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.