Advanced Oropharyngeal Cancer Research Articles

1069P - Primary surgery versus chemoradiotherapy for advanced oropharyngeal and hypopharyngeal cancer: A propensity-score matched study using a nationwide database

1069P - Primary surgery versus chemoradiotherapy for advanced oropharyngeal and hypopharyngeal cancer: A propensity-score matched study using a nationwide database

Osteoradionecrosis of the hyoid bone after intra-arterial chemoradiotherapy for oropharyngeal cancer: MR imaging findings

BackgroundOsteoradionecrosis (ORN) of the hyoid bone sometimes induces severe front neck infection and can cause laryngeal stenosis and carotid rupture. Although ORN of the hyoid bone is known to be a complication of chemoradiotherapy for head and neck cancer, there has been no basis for its evaluation. Our purpose is to present the clinical and MR imaging features of ORN of the hyoid bone.MethodsThe study group comprised patients with advanced oropharyngeal cancer treated with targeted intra-arterial cisplatin infusion with concomitant radiotherapy. ORN of the hyoid bone was identified on the basis of decreased signal intensity of the bone marrow on T1WI images. Signal intensity on T2WI images was used to distinguish between inflammation and fibrosis.ResultsA total of 39 pre-treatment MR images and follow-up MR images were reviewed. ORN of the hyoid bone were detected in 30% of patients after treatment, with 23% of them showing inflammation and 7.7% fibrosis. Two patients developed severe neck infection and received antibiotics and underwent surgical intervention by tracheostomy and resection of the hyoid bone.ConclusionOur MR imaging study showed that ORN of the hyoid bone is not particularly rare in patients with oropharyngeal cancer treated with chemoradiotherapy. Clinicians should evaluate images carefully to prevent the development of severe complication due to infection associated with ORN of the hyoid bone.

A New Clinical Trial of Neoadjuvant Chemotherapy Combined With Transoral Robotic Surgery and Customized Adjuvant Therapy for Patients With T3 or T4 Oropharyngeal Cancer.

A prospective clinical trial of combination neoadjuvant chemotherapy, transoral robotic surgery (TORS), and customized adjuvant therapy for patients with locally advanced oropharyngeal cancer was conducted. Between July 2009 and October 2016, 31 patients were enrolled in this clinical trial. The primary lesions were located in the tonsils of 27 patients and in the base of the tongue of 4 patients. Of the 31 patients, 16 (51.6%) were classified as T3 and 15 patients (48.4%) as T4a. Three patients (9.7%) had stage 3 disease, and 28 (90.3%) had stage 4 disease. The 5-year overall survival rate was 78.7%; the 5-year disease-specific survival rate was 85%; and the 5-year disease-free survival rate was 80.8%. At the final follow-up visit, 26 patients were alive with no evidence of disease, and 1 was alive with disease. Four patients died during the study: two of tumor-node-metastasis (TNM)-related disease and two of another condition. All the patients tolerated an oral diet at an average of 7.4 days postoperatively. At the subjective swallowing evaluation using the Functional Outcome Swallowing Scale score, 83.9% of the patients exhibited favorable outcomes. No patient was permanently dependent on a feeding tube. All the patients breathed and phonated in the absence of a permanent tracheotomy at the final follow-up evaluation. The treatment strategy in this study afforded good oncologic and functional outcomes for patients with locally advanced oropharyngeal cancer. Although future large-scale multicenter studies with longer follow-up periods are needed, this study showed that neoadjuvant chemotherapy combined with TORS is useful for treating advanced oropharyngeal cancer.

Survival benefit of surgical approach for advanced oropharyngeal and hypopharyngeal cancer: A retrospective analysis.

Head and neck cancer is increasingly being managed through nonsurgical approaches. Evidence comes from studies that have mainly examined patients with laryngeal cancer. Few studies, with limited sample size, have focused on the comparative outcomes of surgical and nonsurgical approaches in patients with advanced oropharyngeal or hypopharyngeal cancer. Using a national cancer database, we identified 1603 and 1512 patients with clinical stage III/IVA oropharyngeal and hypopharyngeal cancer, respectively, treated between 2004 and 2009. The study cohort was followed until 2012, and analyzed through Kaplan-Meier survival analysis and Cox regression. Overall, 31.4% of patients with advanced oropharyngeal cancer and 42.2% of patients with hypopharyngeal cancer received surgery as their primary treatment. Receiving primary surgery for advanced oropharyngeal and hypopharyngeal cancer was associated with higher survival rates after controlling for potential confounders. We recommend that surgery be considered a first-line treatment for advanced oropharyngeal and hypopharyngeal cancers.

Metabolic Tumor Volume and Total Lesion Glycolysis in Oropharyngeal Cancer Treated With Definitive Radiotherapy: Which Threshold Is the Best Predictor of Local Control?

In the context of oropharyngeal cancer treated with definitive radiotherapy, the aim of this retrospective study was to identify the best threshold value to compute metabolic tumor volume (MTV) and/or total lesion glycolysis to predict local-regional control (LRC) and disease-free survival. One hundred twenty patients with a locally advanced oropharyngeal cancer from 2 different institutions treated with definitive radiotherapy underwent FDG PET/CT before treatment. Various MTVs and total lesion glycolysis were defined based on 2 segmentation methods: (i) an absolute threshold of SUV (0-20 g/mL) or (ii) a relative threshold for SUVmax (0%-100%). The parameters' predictive capabilities for disease-free survival and LRC were assessed using the Harrell C-index and Cox regression model. Relative thresholds between 40% and 68% and absolute threshold between 5.5 and 7 had a similar predictive value for LRC (C-index = 0.65 and 0.64, respectively). Metabolic tumor volume had a higher predictive value than gross tumor volume (C-index = 0.61) and SUVmax (C-index = 0.54). Metabolic tumor volume computed with a relative threshold of 51% of SUVmax was the best predictor of disease-free survival (hazard ratio, 1.23 [per 10 mL], P = 0.009) and LRC (hazard ratio: 1.22 [per 10 mL], P = 0.02). The use of different thresholds within a reasonable range (between 5.5 and 7 for an absolute threshold and between 40% and 68% for a relative threshold) seems to have no major impact on the predictive value of MTV. This parameter may be used to identify patient with a high risk of recurrence and who may benefit from treatment intensification.

Developing and validating a multivariable predictive biomarker for treatment selection for oropharyngeal squamous cell carcinoma: The PREDICTR-OPC study.

6004 Background: To date there are no validated predictive tests to inform treatment selection for patients with oropharyngeal cancer (OPC). Currently treatment is decided on disease resectability, clinician preference and patient choice. Methods: Objective To develop a predictive test to select treatment for advanced OPC. Participants Training cohort: 543 cases from 10 cancer centres. External validation cohort: 442 cases from 3 centres. Design Multivariable logistic regression of 8 clinical parameters and 10 biomarkers to develop biomarker-only and composite clinical/biomarker predictive models; subsequently validated on a separate cohort. Biomarkers scored by ≥2 ‘blinded’ pathologists. Outcomes Primary: overall survival (OS). Results: 724 males, 261 females; Median follow-up =8.8 (6.86-10.47) years. More validation cases received surgery (53.5% vs 37.9%, p=0.001) and fewer received chemo/radiotherapy (42%vs67.5%; p=0.001) compared to training cohort. The biomarker-only model performed better than the clinical/biomarker one. The final OS model - comprising p16, high risk HPV DNA ISH, survivin and tumour infiltrating lymphocyte score (TILS)- was not only prognostic for OS, but importantly was predictive for surgery+/-adjuvant RT over CRT (3yr OS 63%, vs 42.5% respectively) in the High Risk group. Treatments were equally effective in the Low Risk group. The RFS model (p16, PLK1, survivin, TILS) was prognostic, but not predictive for treatment. Validation testing confirmed good calibration and concordance (C-index =0.73; 0.68-0.79). The OS model remained prognostic and predictive for surgical treatment in High Risk group (HR=0.51; 95%CI= 0.3-0.85, p=0.01). Conclusions: To our knowledge, this is the first-ever validated model for treatment selection in HNC. Clinicians can now recommend the treatment most likely to be effective on the basis of an easily-applied, relatively inexpensive panel of 4 biomarkers. [Table: see text]

EP-1027: Evaluation of induction chemotherapy followed by radiation therapy in advanced oropharyngeal cancers

EP-1027: Evaluation of induction chemotherapy followed by radiation therapy in advanced oropharyngeal cancers

Definitive Intensity-modulated Radiation Therapy in Elderly Patients with Locally Advanced Oropharyngeal Cancer.

To evaluate the treatment tolerance and clinical outcomes in patients aged 70 years and older with locally advanced oropharyngeal cancer treated by definitive intensity-modulated radiation therapy (IMRT). We retrospectively analyzed 15 consecutive elderly patients, with histologically-proven squamous cell carcinoma of the oropharynx, staged T3-4 with or without involved lymph nodes at diagnosis, who received definitive sequential IMRT (70 Gy; 2 Gy/fraction). Adult Comorbidity Evaluation-27 (ACE-27) score was calculated and its influence on treatment tolerance and clinical outcomes was analyzed. A total of 15 patients were included with a median age of 77 years (range=70-88 years). At baseline, 8 patients (53.3%) had an ACE-27 score of 1, and the remainder (n=7, 46.7%) had a comorbidity index of 0. All patients completed programmed IMRT treatment, without any reduction of total dose. Oral pain and mucositis were the most common acute side-effects, classified as grade 3 in 6 patients (40%) only. Xerostomia was reported in 13 patients (86.7%), without severe manifestation. There was no hematological toxicity. ACE-27 score was not related to higher severe acute toxicity. No patients experienced grade 3 or more late toxicity. Five-year overall survival and disease-free survival rates were 63.6% (95% confidence interval=32.7-83.3%) and 55% (95% confidence interval=24.4-77.6%), respectively. Comorbidity score did not influence survival outcomes, both overall survival (p=0.46) and disease-free survival (p=0.55). Treatment tolerance, as well as survival outcomes were good in elderly oropharyngeal cancer patients treated with definitive sequential IMRT. Due to age and comorbidity, no dose or volume reduction for IMRT should be considered in this setting of patients. A prospective randomized trial with a large sample size should be conducted to confirm our results.

Prevalence of obstructive sleep apnoea syndrome following oropharyngeal cancer treatment: A prospective cohort study

To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life. Prospective cohort study. University Teaching Hospital of La Conception, Marseille, France. Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy. Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject. The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03). Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer.

Cost-effectiveness of response evaluation after chemoradiation in patients with advanced oropharyngeal cancer using 18F\u2013FDG-PET-CT and/or diffusion-weighted MRI

BackgroundConsiderable variation exists in diagnostic tests used for local response evaluation after chemoradiation in patients with advanced oropharyngeal cancer. The yield of invasive examination under general anesthesia (EUA) with biopsies in all patients is low and it may induce substantial morbidity. We explored four response evaluation strategies to detect local residual disease in terms of diagnostic accuracy and cost-effectiveness.MethodsWe built a decision-analytic model using trial data of forty-six patients and scientific literature. We estimated for four strategies the proportion of correct diagnoses, costs concerning diagnostic instruments and the proportion of unnecessary EUA indications. Besides a reference strategy, i.e. EUA for all patients, we considered three imaging strategies consisting of 18FDG-PET-CT, diffusion-weighted MRI (DW-MRI), or both 18FDG-PET-CT and DW-MRI followed by EUA after a positive test. The impact of uncertainty was assessed in sensitivity analyses.ResultsThe EUA strategy led to 96% correct diagnoses. Expected costs were €468 per patient whereas 89% of EUA indications were unnecessary. The DW-MRI strategy was the least costly strategy, but also led to the lowest proportion of correct diagnoses, i.e. 93%. The PET-CT strategy and combined imaging strategy were dominated by the EUA strategy due to respectively a smaller or equal proportion of correct diagnoses, at higher costs. However, the combination of PET-CT and DW-MRI had the highest sensitivity. All imaging strategies considerably reduced (unnecessary) EUA indications and its associated burden compared to the EUA strategy.ConclusionsBecause the combined PET-CT and DW-MRI strategy costs only an additional €927 per patient, it is preferred over immediate EUA since it reaches the same diagnostic accuracy in detecting local residual disease while leading to substantially less unnecessary EUA indications. However, if healthcare resources are limited, DW-MRI is the strategy of choice because of lower costs while still providing a large reduction in unnecessary EUA indications.

Impact of fraction size on locally advanced oropharyngeal and nasopharyngeal cancers treated with chemoradiation

ObjectivesAlthough chemoradiation regimens have used various fraction sizes, it remains unclear how differences in fraction size impact outcomes. Materials and methodsUsing the National Cancer Database, we identified patients with nasopharynx or oropharynx cancers treated between 2004 and 2012 with chemoradiation using fraction sizes of 1.8Gy (n=1612), 2Gy (n=8092) or 2.12Gy (n=1660). Comparisons between fraction sizes were made in the entire cohort and in a propensity matched cohort. ResultsMedian follow-up was 38.1m. Patients receiving 2.12Gy per fraction were more likely to be treated from 2007 to 2012, to be treated at an academic center, to have T3-T4 tumors and to have oropharyngeal primaries. The 3year overall survival for patients treated with 1.8Gy, 2Gy and 2.12Gy fraction sizes was 72.9%, 77.8% and 83.3%, respectively (P<0.0001). 2.12Gy fraction size was associated with improved survival in patients with nasopharynx cancer (P=0.03), base of tongue cancer (P<0.0001) and tonsil cancer (P=0.0002). On multivariate analysis, improved survival was associated with 2.12Gy fraction sizes compared to 2Gy (HR 1.23, 95% CI 1.09–1.40, P=0.001) or 1.8Gy (HR 1.36, 95% CI 1.17–1.58; P<0.0001) fractions sizes. ConclusionChemoradiation regimens using 2.12Gy fraction sizes likely have a potential advantage in select nasopharynx and oropharynx cancer patients based on age, treatment facility and radiotherapy technique. However, it remains unclear if this survival advantage reflected improved disease control due to lack of locoregional control data.

PO-145: Definitive sequential radiotherapy in elderly patients with locally advanced oropharyngeal cancer

PO-145: Definitive sequential radiotherapy in elderly patients with locally advanced oropharyngeal cancer

Advanced Oropharyngeal Cancer Can Be Easily Missed During Esophagogastroduodenoscopy.

The case of an elderly man with an advanced oropharyngeal cancer that was missed during esophagogastroduodenoscopy is described. He was referred for endoscopic resection of superficial esophageal squamous cell neoplasms. He died a month after referral due to an advanced oropharyngeal cancer with a metastatic lesion to the brain. Patients with esophageal squamous cell carcinoma are high risk for head and neck cancer. The pharynx is the most common site for cancer in the head and neck region. Consequently, the pharynx should be observed carefully when patients with esophageal squamous cell carcinoma undergo esophagogastroduodenoscopy.LEARNING POINTSHead and neck cancer develops in approximately 10% of patients with esophageal squamous cell carcinoma.The pharynx should be observed carefully when patients with esophageal squamous cell carcinoma undergo esophagogastroduodenoscopy because the pharynx is the most common site for cancer in the head and neck region.Sedation using narcotic drugs can reduce the gag reflex but still allow patients to vocalize and offer adequate conditions for pharyngeal observation during esophagogastroduodenoscopy.

A PET-based nomogram for oropharyngeal cancers

PurposeIn the context of locally advanced oropharyngeal cancer (LAOC) treated with definitive radiotherapy (RT) (combined with chemotherapy or cetuximab), the aims of this study were: (1) to identify PET-FDG parameters correlated with overall survival (OS) from a first cohort of patients; then (2) to compute a prognostic score; and (3) finally to validate this scoring system in a second independent cohort of patients. Materials and methodsA total of 76 consecutive patients (training cohort from Rennes) treated with chemoradiotherapy or RT with cetuximab for LAOC were used to build a predictive model of locoregional control (LRC) and OS based on PET-FDG parameters. After internal calibration and validation of this model, a nomogram and a scoring system were developed and tested in a validation cohort of 46 consecutive patients treated with definitive RT for LAOC in Lausanne. ResultsIn multivariate analysis, the metabolic tumour volume (MTV) of the primary tumour and the lymph nodes were independent predictive factors for LRC and OS. Internal calibration showed a very good adjustment between the predicted OS and the observed OS at 24 months. Using the predictive score, two risk groups were identified (median OS 42 versus 14 months, p < 0.001) and confirmed in the validation cohort from Lausanne (median OS not reached versus 26 months, p=0.008). ConclusionsThis is the first report of a PET-based nomogram in oropharyngeal cancer. Interestingly, it appeared stronger than the classical prognostic factors and was validated in independent cohorts markedly diverging in many aspects, which suggest that the observed signal was robust.

Impact of Different Treatment Concepts on Regional Failure in Advanced Oropharyngeal Cancer.

The management of patients with advanced oropharyngeal cancer is complex and mostly requires a multidisciplinary treatment approach. In general, organ preservation by primary concurrent radiochemotherapy (RCT), or surgery completed by adjuvant radiotherapy are established treatment strategies for these patients. However, it is unclear if primary treatment has an effect on regional tumor control. The purpose of the present study was to evaluate the regional control after different treatment concepts. Clinical data, including histological and radiological results, of 82 patients with T2-T3 oropharyngeal cancer and N2 neck were retrospectively analyzed. They underwent either RCT with salvage neck dissection (ND) (n=45), or primary transoral surgery with ND and adjuvant RCT (n=37). In all cases, the primary tumor was successfully treated, without evidence of local failure in the follow-up. Overall, 11 (13.4%) patients developed regional failure during the follow-up. There were no significant differences in frequency of regional failure (p=0.75), distant metastasis (p=0.35) and overall survival (p=0.22) between treatment groups. However, 5-year disease-free survival was significantly worse (39.0% vs. 57.0%) for patients treated by RCT, with more frequent regional failure detected compared to surgically-treated patients in univariate analysis (p=0.04). Treatment concept does not seem to affect regional tumor control in advanced oropharyngeal cancer after successful treatment of the primary tumor.

Impact of Induction Chemotherapy in Locally Advanced HPV-negative Oropharyngeal Cancer. A Propensity Score-matched analysis.

To estimate the clinical outcomes of induction chemotherapy (IC) followed by standard chemoradiotherapy (CRT) and CRT alone in patients with locally advanced human papilloma virus (HPV)-negative oropharyngeal squamous cell carcinoma. Consecutive patients with histologically-proven HPV-negative squamous cell carcinoma of the oropharynx were included and treated with IC-CRT or CRT alone. In order to compare treatment outcomes and toxicity between groups, patients were matched by primary tumor site and clinical disease stage. Overall survival (OS), disease-free survival (DFS) and metastasis-free survival (MFS) curves were calculated with the Kaplan-Meier method. Nine IC patients and 18 CRT patients were included. All patients completed the programmed treatment. The median follow-up was 38 months. There were no statistically significant differences in OS and DFS between groups. The 5-year MFS was 88.9% and 50.8% in the IC-CRT group, respectively. There was no meaningful difference in toxicity between patients. In HPV-negative patients with locally advanced oropharyngeal cancer, adding IC to standard CRT may increase the MFS rate. However no significant differences in OS and DFS were observed. More studies are needed to better elucidate the role of IC in this setting.

992P - Clinical-dosimetric analysis of factors predisposing to chronic dysphagia measured using CTCAE criteria among locally advanced oropharyngeal cancer patients treated definitely by intensity modulated radiotherapy with concurrent chemotherapy

992P - Clinical-dosimetric analysis of factors predisposing to chronic dysphagia measured using CTCAE criteria among locally advanced oropharyngeal cancer patients treated definitely by intensity modulated radiotherapy with concurrent chemotherapy

Tratamiento no quirúrgico en cáncer epidermoide de orofaringe avanzado. Análisis de resultados oncológicos en función del subsitio tumoral y fraccionamiento de radioterapia

ObjectiveTo report results of our concomitant radiochemotherapy protocol for advanced oropharyngeal cancer. Materials and methodsRetrospective study. Concomitant radiochemotherapy was performed with weekly cisplatin. Conventional fractionation (CF), hyperfractionation (Hfx) or accelerated fractionation with concomitant boost (FABC) were accepted. Overall survival (OS), Disease-free survival (RFS), Local relapse-free survival (LRFS) and Regional relapse-free survival (RRFS) were calculated, according subsite and radiotherapy fractionation. ResultsWe found 87 patients. Median follow-up: 120 months. 53%, 30% and 17% received FC, FABC, Hfx respectively. OS at 2, 5 and 10 years was 73%, 61% and 43% respectively. The 5-year OS was, by anatomic subsite: Tonsillar 74%, 33% soft palate, base of tongue 33%, and 33% for posterior pharyngeal wall. By comparing the OS in tonsil versus other subsites we found statistically significant difference in favor of tonsillar cancer (P<.001). Median OS for tonsillar cancer was not achieved, while in other subsites was 22 months.DFS was different in different subsites, better for amygdala and different among different fractionations, better for Hfx, reaching significant differences. The same trends were demonstrated in LRFS and RRFS.We observed a 23% of second cancers, being lung the most common site. ConclusionConcomitant radiotherapy with weekly cisplatin is an appropriate treatment for oropharyngeal cancer. It provides excellent outcomes in tonsillar cancer, especially with modified fractionation and Hfx type. For other subsites it seems advisable to explore a new treatment approach.

Impact of prophylactic gastrostomy or reactive NG tube upon patient-reported long term swallow function following chemoradiotherapy for oropharyngeal carcinoma: A matched pair analysis

The purpose of this matched pair analysis is to assess patient-reported long term swallow function following chemoradiotherapy for locally advanced oropharyngeal cancer in relation to the use of a prophylactic gastrostomy or reactive nasogastric (NG) tube. The MD Anderson Dysphagia Inventory (MDADI) was posted to 68 consecutive patients with stage III/IV oropharyngeal squamous cell carcinoma who had completed parotid sparing intensity modulated radiotherapy with concurrent chemotherapy between 2010 and 2012, had not required therapeutic enteral feeding prior to treatment, minimum 2years follow up post treatment, and who were disease free. 59/68 replies were received, and a matched pair analysis (matching for T and N stage) was performed for 52 patients, 26 managed with a prophylactic gastrostomy and 26 with an approach of an NG tube as needed. There were no significant differences in patient demographics, pre-treatment diet and treatment factors between the two groups. Patient-reported swallowing function measured using the MDADI was superior for patients managed with an NG tube as required compared with a prophylactic gastrostomy: overall composite score 68.1 versus 59.4 (p=0.04), global score 67.7 versus 60 (p=0.04), emotional subscale 73.5 versus 60.4 (p<0.01), functional subscale 75.4 versus 61.7 (p<0.01), and physical subscale 59.6 versus 57.1 (p=0.38). Compared with an approach of an NG tube as required, the use of a prophylactic gastrostomy was associated with inferior long term patient-reported long term swallow outcomes.

Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach.

The purpose of this study was to present our evaluation of the outcome of oropharyngeal cancer managed with neoadjuvant chemotherapy and transoral surgery (TOS) with neck dissection as definitive treatment. This is a case series of 17 patients with advanced oropharyngeal cancer who were treated with neoadjuvant chemotherapy followed by TOS. The treatment details and oncologic outcome are reported. The volumetric response of the tumor to neoadjuvant chemotherapy is evaluated and validated by histopathology. Seventeen patients with TNM stages III and IV oropharyngeal cancer constitute this series for survival analysis. On a median and mean follow-up of 31 and 40 months, respectively, 16 of the 17 patients were alive without recurrence. Disease-specific survival (DSS) and overall survival (OS) at 3 years were 94.1%. Adjuvant chemotherapy followed by TOS and neck dissection is a feasible and efficacious novel therapeutic approach for definitive management of moderately advanced oropharyngeal cancer, reserving radiotherapy (RT) for salvage or adverse features. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1837-1846, 2016.