When, if ever, would you consider dose de-escalation for HPV-associated non-oropharyngeal HNSCC?

This is a very complex question, as the issues of dose, and de-escalation can be difficult to sum up in an hour lecture let alone a Mednet query. Personally, for me, efforts to lessen volume and doses to subclinical disease are a bit more interesting.

Quoting Cmelak et al., PMID 34043410 (2021) in an...

No

No.

It is still investigational and not standard of care.

HPV+ status is not an independent prognostic factor in non-OPhx primaries as has been proven to be in OPhx primaries (or at least not anywhere near the same strength of association), and thus, I would not recommend any consideration of de-intensifying therapy in a HPV+ Non-OPhx cancer in the absence...