Simmer down.

Where are we supposed to go with de-escalation studies for HPV-mediated head and neck (H&N) cancer after the disappointing results of RTOG 1016 and DE-ESCALATE? This article from the H&N Cancer InterGroup describes a framework for future de-escalation in both clinical trials and clinical practice. It focuses on the appropriate design of phase 2 and 3 clinical trials exploring other ways of de-intesifying treatment (e.g., with a lower radiation dose). There was again a strong caution not to adopt any de-escalation techniques in clinical practice off-trial without further high-level evidence. However, implementation of modern treatment planning techniques to improve critical structure dosimetry will likely continue the progress. TBL: De-esclation of definitive radiation for lower-risk H&N cancers needs to be brought home with completion of large-scale clinical trials that employ novel radiation techniques. | Mehanna, J Clin Oncol 2020