Is there something other than stage and smoking status we should be using when identifying which patients benefit most from “de-intensified” therapies for HPV+ oropharyngeal cancer? This common sense study demonstrates the validated “omega score” can help identify which patients are at the least risk for cancer to be the cause of death. Importantly, this can be due both to the cancer itself posing very little risk but also to other health issues posing more of a threat than HPV+ cancer. As such, the omega score calculates age, performance status and gender in addition to stage, smoking and p16-status. A higher score denotes higher risk of cancer versus non-cancer death and thus indicates bigger benefit from more intensive therapies. When retrospectively applied to 444 patients receiving definitive radiation for p16+ oropharyngeal cancer, lower omega scores were indeed associated with significantly lower rates of cancer events. In other words, if the goal is to keep cancer from being the thing that takes you out, a young fit patient with “low-risk” disease may very well stand to benefit from intensive therapy where an older, frail patient with “intermediate-risk” disease may benefit most from less intensive therapy. The authors conclude: “Considering relative event risk when defining candidates for deintensification is justifiable both mathematically and empirically” and should be explored as inclusion criteria in future investigations in this space. | Morse, Int J Radiat Oncol Biol Phys 2024
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