Does p16 status influence your decision when choosing between surgery and definitive chemo-RT for head and neck patients?

I am assuming that when you say "surgery" you are specifically referring to transoral robotic or transoral laser surgeries and not the traditional mandible- splitting surgeries for oropharyngeal cancers.

Currently p16 status does not make a difference in offering transoral surgery to patients. FDA approval for transoral robotic surgery (eg. using the DaVinci system) is only for T1 and T2 tumors. Any T3 and T4 tumors should be treated with radiation and concurrent chemotherapy. At our institution, for T1 and T2 tumors, a multidisciplinary evaluation is done and patients are seen in a multidisciplinary clinic and for eligible patients, both options are presented to the patients with a detailed discussion of the logistics and side effects of bo...

To follow-up on @Dr. First Last's final point regarding the absence of randomized data on "surgical intensification" for p16-negative oropharyngeal cancers, our recent NCDB analysis observed similar overall survival for cT1-2N1-2b p16-negative OPSCC patients receiving upfront surgical therapy (~60% of whom received adjuvant chemo-RT) vs. upfront chemo-RT (Kelly JR et al., JAMA Oncol 2017). Despite the usual limitations of the NCDB (including lack of key endpoints other than overall survival), this hypothesis-generating study suggests that surgical intensification may not necessarily be indicated routinely for this population.