How would you approach a patient with synchronous HPV-mediated bilateral tonsil primary with ipsilateral lymph nodes who cannot receive chemotherapy?  

DAHANCA style - 6 Fx per week, one day a week BID. This study was for glottic larynx, but can extrapolate. Also, the Danes studied a complete BID approach for unresectable head and neck cancer that had great results, delivering 76 Gy in 56 Fx. 

Dahanca accelerated RT, 6# per week, is very effective at mitigating omission of chemotherapy for T1-2N1 HPV-related OPC (Barcelona et al., PMID 40262333).The stage of primary disease and resectability isn’t given, but an alternative approach to explore in this patient would be upfront surgery...