How do you manage small oropharyngeal cancers with N1 or N2 disease?

For T1-2N1 oropharyngeal cancers there is data from MD Anderson and Toronto that they do quite well with RT alone. These patients are excluded from current RTOG chemo-RT protocols. It is possible that more advanced tumors that are HPV(+) in non- or remote smokers will also do very well with RT alone...

We prefer to manage small oropharyngeal (N1-2) cancers with primary surgical resection, preferably transoral robotic surgery to minimize surgical morbidity. This approach allows precise staging of the tumor (pathologic staging) and tailoring of the need for and type of adjuvant therapy based on the ...

This is an interesting and evolving area. TORS is an excellent approach but patient selection remains challenging. Of note in the 2012 Mayo series, 62% received adjuvant chemoradiation and only 17% received TORS alone. Risk-stratification for adjuvant treatment after TORS is an evolving area with ma...