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Summary key points
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•
Modified fractionation (hyperfractionation and/or acceleration) is superior to conventional
fractionation
•
Hypoxic sensitizers (e.g. nimorazole) improves tumor control and survival without enhancing
radiation morbidity
•
Concomitant platinum‐based chemotherapy is more effective than RT alone for younger patients in
good performance status with and advanced stage tumours. Acute and late toxicity is increased
•
EGFR inhibition combined with radiotherapy (but not chemoRT) results in enhancement of tumor
response
•
The optimal combination of these ’radiotherapy intensifiers’ is still unsettled
•
All of the above in turn needs to be re‐evaluated in the light of the
major impact of HPV on radiation response and prognosis
•
HPV status needs to be taken into account whenever a clinical trial
is conducted or interpreted (identification, stratification..)
•
Until such evidence is collected, HPV‐status should not influence
intensity of treatment
•
De‐escalation trials for HPV+ patients are ongoing
•
Although there is currently much focus on the HPV‐positive
patients it is important not to forget the HPV negative patients
,
‐
,
who have poor prognosis and need better strategies!