Post-operative Adjuvant Treatment for HPV-positive Tumours (PATHOS)

To be considered for the PATHOS trial, you would generally need to have throat cancer (specifically, oropharyngeal squamous cell carcinoma) that has been confirmed by a biopsy. Your cancer needs to be at a certain stage – not too early and not too advanced, usually T1-T3, N0-N2b. Importantly, a team of specialists (MDT) must agree that surgery to remove the tumour through the mouth, along with removing lymph nodes in the neck, is the best first step for you.

You also need to be at least 18 years old and capable of giving your full consent to join the study after understanding all the details. A crucial requirement is that your cancer must be confirmed as HPV-positive. This is checked using specific lab tests. If these tests show your cancer is HPV-negative, or if there are certain advanced features to your cancer (like it being too big for surgery through the mouth, or having spread too widely), then unfortunately you wouldn't be able to join the trial.

Additionally, if you currently smoke and have certain lymph node involvement, or if you have pre-existing severe swallowing difficulties not related to your cancer, you would also likely not be eligible. This trial focuses on a very specific group of patients where this personalised treatment approach might be most beneficial.

If you decide to take part in the PATHOS trial, after giving your consent, your doctors will first confirm that your tumour is HPV-positive. Before your surgery, you'll have several assessments to check your swallowing and overall quality of life. This might involve completing questionnaires, a special X-ray called a videofluoroscopy to watch you swallow, and a simple water swallowing test. After surgery to remove your tumour and any affected lymph nodes, specialists will examine the removed tissue in detail.

Based on these detailed findings, you will be placed into one of the study groups. Some groups might receive less intense follow-up treatment (like radiotherapy), while others might not need any additional treatment. The specific follow-up treatments will be determined by the study protocol, depending on the risk factors found in your tumour. You'll continue to have regular check-ups and assessments, including those for swallowing and quality of life, throughout the study to see how well the treatments are working and how you are feeling. The overall duration of your participation, including follow-up, will be several years, as researchers need to monitor long-term outcomes like survival and cancer recurrence.