[Correspondence] Misclassification of p16-positive, HPV-negative patients biases de-escalation trials

We read with interest the Article by Daniel Ma and colleagues in The Lancet Oncology.1 Ma and colleagues should be congratulated on completing a randomised trial of de-escalated radiotherapy in patients with p16-positive oropharyngeal squamous cell carcinoma. The authors report progression-free survival, local regional control, freedom from distant metastases, and overall survival as secondary endpoints. The de-escalation protocol resulted in a reduction in progression-free survival, local regional control, and systemic control in patients who received de-escalated treatment with extracapsular extension compared with patients who received standard of care.