What role do you see for functional imaging in selecting patients with HPV-associated oropharyngeal cancer for radiation dose de-escalation?

This study, led by Dr. @Dr. First Last, is unique in using F-MISO PET to select patients for a notably aggressive de-escalation plan, to a 30 Gy total dose for responding patients. We need to wait for long-term results before accepting it in the clinic, notwithstanding that F-MISO is not widely available (it is not available in my institution). While initial studies of de-escalation have been promising, randomized studies comparing de-escalation to standard therapy have thus far failed to demons...

Finding the individual dose for a particular tumor has been the holy grail of our field. First attempts at this were that, rather than using fixed doses, in the 1950 and 60s tumor response was used to predict outcome and as a “stopping” point for treatment.

It was further recognized that even 30 Gy can cure some tonsil cancers. Despite this, our field has gone to a one-dose-fits-all approach. This is reflected in RTOG 1016, one of the first NRG/RTOG trials to include T1 disease and still treat al...