Figure 1. Age Standardized Rate of Oropharyngeal Squamous Cell Carcinoma (OPSCC) in the UK, 2002-2011. Data courtesy of the UK HPV Prevalence Study (1)

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Presentation transcript:

Figure 1. Age Standardized Rate of Oropharyngeal Squamous Cell Carcinoma (OPSCC) in the UK, 2002-2011. Data courtesy of the UK HPV Prevalence Study (1) [A. Schache/N.Powell].

Figure 2. Estimated Age Standardized Incidence Rate of HPV-positive and HPV-negative OPSCC in the UK, 2002-2011. Data courtesy of the UK HPV Prevalence study (1) [A.Schache/N.Powell]. For each year, the gender-specific proportion of HPV-positive and HPV-negative samples was multiplied by the UK gender-specific incidence rates to estimate Age Standardised Rates (ASR) for HPV-positive and HPV-negative OPSCC.

Figure 3. Intensity Modulated Radiotherapy (IMRT) plan for left tonsillar carcinoma Gross Tumour Volumes (GTV) for left tonsillar primary and retropharyngeal node (yellow); Clinical Target Volume (CTV1) for radical dose RT (red); CTV2 for prophylactic dose RT (purple); 62.7Gy, 54Gy, 51.3Gy and 48 Gy isodose lines (shown in green, blue and mustard respectively).

PATHOS Trial schema Transoral surgery A No adjuvant treatment Pathology assessment A Low risk No adjuvant treatment HPV positive OPSCC T1-3 N0-N2b Randomise Transoral surgery +neck dissection B1 60Gy in 30# (control) Intermediate risk B B2 50Gy in 25# (test) Randomise C1 60Gy in 30#+Cisplatin (control) High risk C C2 60Gy in 30# (test)

Figure 4. PATHOS (Post-operative adjuvant treatment for HPV-positive tumours)- study schema. Patients with T1-T2 N0-N2b HPV-positive OPSCC undergo transoral surgery and neck dissection before being stratified into groups (A, B, C) based on pathological risk factors. Group A (no risk factors) have no adjuvant treatment. Group B (N2, close margins, perineural/vascular invasion) are randomised to 60Gy (control arm) or 50Gy (test arm) of RT. Group C (extracapsular spread and/or positive margins) are randomised to POCRT (control arm) or PORT (test arm). The primary endpoint is patient-reported swallowing function (MDADI score) 12 months after treatment. Secondary outputs include overall survival, loco-regional control and quality of life. The aim is to determine if TOS followed by reduced intensity adjuvant treatment can improve long-term function, whilst maintaining high survival rates.