Jul 28, 2017 - a better response to the accepted line of management of chemoradiation. Hence, it was proposed to deintensify the treatment for this group of ...
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Editorial
Is Human Papilloma Virus Positivity in Oropharyngeal Cancers a Game Changer in Indian Subcontinent? The rising incidence of oropharyngeal carcinoma and their relationship with human papilloma virus (HPV) has been alarming in the last decade. HPV‑induced oropharyngeal carcinoma have been defined as a different subset with improved prognosis.[1] The latest AJCC 8th edition[2] and NCCN guideline 2017[3] have divided the oropharyngeal carcinoma and pathological nodal staging separately compared to HPV negative carcinoma emphasizing over the fact that HPV positivity is a good prognostic factor and a game changer in the realm of oropharyngeal carcinoma. This is very true for the Western world and their changing population subset of younger nonsmoking patients with oropharyngeal cancer. However, the point to ponder on whether HPV actually a gamer changer in Indian scenario?? First, the incidence of HPV‑induced oropharyngeal carcinoma is debatable in the case of the Indian subcontinent with the majority of patients with oropharyngeal cancer had a history of tobacco abuse in the form of chewable tobacco or smoking beedis/cigarettes. Data from Centers for Disease Control and Prevention, USA found the significant disparity in prevalence of HPV between various racial groups in the USA. They found that among american white people, 82 men per million suffered from HPV‑induced oropharyngeal cancer compared to Asian group which had only 20 men per million suffering from HPV‑induced oropharyngeal cancer in the USA.[4] The other debate with the advent of HPV is the de‑intensification of treatment. To start with, there were reports of HPV‑induced oropharyngeal malignancy having a better response to the accepted line of management of chemoradiation. Hence, it was proposed to deintensify the treatment for this group of patients with scaling down to radical radiotherapy rather than chemoradiotherapy and feasibility of reducing the dosage of radiotherapy. Ang et al.[5] found that intermediate risk group with a history of smoking
