Head-and-neck squamous cell carcinoma carcinoma (HNSCC) is a disease where the prognosis varies substantially between patients. Human papilloma virus (HPV) positive oropharyngeal carcinoma is, in relative terms, a favorable subtype with a 3-year overall survival (OS) of around 80% [1]. It has been suggested that treatment de-intensification would be possible in this group without compromising the treatment effect, and several such studies are ongoing [2]. This begs the question whether we can identify subset of HPV positive patients where de-intensification may be detrimental for long term survival due to a – for the group – unfavorable disease characteristics.
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