In which oropharynx patients would you recommend TORS vs upfront RT or chemo-RT?

With MC1675 and ORATOR2 coming out at ASTRO21, and ECOG3311 published shortly afterwards, this topic is now particularly germane. Due to the recent reports on these trials, I'll be writing in the context of possible post-op de-escalation.

I think the first and most important question to ask is, "What...

I prefer TORS for patients with a low probability of requiring additional therapies. Typically this will be the old (7th edition) stage I - III patients, though the stage III would be highly selected, ie non invasive T3 disease or N1 disease that radiographically does not appear to have ENE.

For old...

Phase II randomized data (ORATOR, ASCO 2019) now suggests that swallowing outcomes are superior in T1-2 oropharyngeal cancer HPV+ patients managed with RT rather than TORS.

Only those who have a high likelihood of avoiding postop RT. So roughly 10%.

Trimodality therapy will generally end up being more toxic long term than chemo/XRT, as a rule, especially when considering sites involved with swallowing like the pharynx or base of tongue.

If there are multiple clinically+ nodes on exam or imaging, the risk of needing concurrent post-op therapy w...