Initial treatment of locoregional, nonmetastatic HPV associated oropharyngeal squamous cell carcinoma of the head and neck

HPV: human papillomavirus; TNM: tumor, node, metastasis; RT: radiation therapy; OPSCC: oropharyngeal squamous cell carcinoma; PNI: perineural invasion; LVI: lymphovascular invasion.

* Adjuvant RT with or without concurrent chemotherapy may be indicated for tumors with high-risk findings on postoperative pathology. Adjuvant RT may be offered to those with one node >3 cm, close margins, PNI, or LVI. Adjuvant chemoradiation may be offered to those whose pathology demonstrates extranodal extension with or without positive margins, high number of involved lymph nodes, or positive margins not eligible for further resection.

¶ Single agent RT may be indicated for nonsmoking patients with one small single node without adverse features on clinical evaluation or high quality imaging (eg, ≤3 cm, no radiographic evidence of extranodal extension).

Δ Definitive chemoradiation may be indicated in patients who are active or heavy smokers, or who have one involved node with certain high-risk features suspicious for a more advanced primary tumor or advanced nodal disease on clinical evaluation or radiographic imaging. Examples of such high-risk features include endophytic, ulcerated primary tumors; radiographic evidence of extranodal extension or nodal matting; highly suspicious clustered or small lymph nodes; or involvement of retropharyngeal, level IV, or level V lymph nodes.