T1N1M0 + p16 Squamous Cell Cancer of Base of Tongue With 3.6-cm Node and <1 mm of ENE

1. Definitive external radiation therapy (XRT). The first Orator trial demonstrated a clinically meaningful and statistically significant advantage to XRT in total 3-year M. D. Anderson Dyphagia Inventory scores in patients with base of tongue (BOT) cancers versus transoral robotic surgery (TORS). 1 Nichols AC Theurer J Prisman E et al. Randomized trial of radiotherapy versus transoral robotic surgery for oropharyngeal squamous cell carcinoma: Long-term results of the orator trial. J Clin Oncol. 2022; 40: 866-875 Crossref PubMed Scopus (46) Google Scholar Orator2 found that in all oropharyngeal HPV-associated squamous cell cancers (+HPV-OPSCC), at 1 year, 81% of XRT patients versus 38% of TORS patients enjoyed an unrestricted oral diet (P = .05). 2 Palma DA Prisman E Berthelet E et al. Assessment of toxic effects and survival in treatment deescalation with radiotherapy vs transoral surgery for HPV-associated oropharyngeal squamous cell carcinoma: The Orator2 phase 2 randomized clinical trial. JAMA Oncol. 2022; 8: 1-7 Crossref Scopus (34) Google Scholar Management After an Initial Nononcologic Approach to an HPV+ Head and Neck CancerInternational Journal of Radiation Oncology, Biology, PhysicsVol. 115Issue 5PreviewA 50-year-old woman initially presented to her primary care doctor with an enlarging, painless left neck mass. Workup at an outside hospital including computed tomography of the neck with contrast revealed a 2 × 3 cm cystic mass in the left submandibular region. She underwent ultrasound-guided fine needle aspiration of the mass, which was reported as nondiagnostic, and direct laryngoscopy at the time did not reveal any abnormalities. She underwent excision and dissection of the left neck with pathology showing p16-positive squamous cell carcinoma, and disease present in 1 of 13 dissected nodes measuring 3.6 cm, with focal (<1 mm) extranodal extension. Full-Text PDF