Top Line: What are the long term outcomes following de-intensified adjuvant radiation following transoral surgery for oropharyngeal cancer?
The Study: ECOG-ACRIN 3311 showed favorable outcomes with lower dose (50 Gy) adjuvant RT for intermediate-risk HPV+ OPSCC after TORS. Another phase II trial (AVOID) demonstrated that omitting the primary site from the RT target was relatively safe in well-selected patients. This single-institution phase II trial asked the logical next question: what if you do both at once? It enrolled 149 patients with pT0–T3, pN0–N1 HPV+ OPSCC treated with TORS and neck dissection. Adjuvant RT consisted of 50 Gy in 25 to the at-risk neck (and primary site when indicated), and low risk volumes and the contralateral neck received 45 Gy. The primary site was omitted in 52% of patients (pT1–T2, margins ≥2 mm, no LVI or PNI), while an optional SIB (52.5 to 50 Gy) was allowed for close or positive margins. Concurrent chemotherapy was given to 23%, and 52% were treated with proton therapy. At a median follow-up of 48 months, five-year LRC was 98.0% with no local failures and only two regional recurrences. Five-year OS was 92.6%. Notably, 33 high-risk patients with positive margins and/or >1 mm ENE had no locoregional failures. Only one patient required a feeding tube, grade 3 mucositis was 8%, and grade 3 dysphagia was <1%.
TBL: Long term follow up from this phase 2 study found that pushing the limits of de-intensified adjuvant radiation after TORS for oropharyngeal cancer had a low risk of locoregional failure and mild adverse effects. | Lukens, Int J Radiat Oncol Biol Phys 2026
The Study: ECOG-ACRIN 3311 showed favorable outcomes with lower dose (50 Gy) adjuvant RT for intermediate-risk HPV+ OPSCC after TORS. Another phase II trial (AVOID) demonstrated that omitting the primary site from the RT target was relatively safe in well-selected patients. This single-institution phase II trial asked the logical next question: what if you do both at once? It enrolled 149 patients with pT0–T3, pN0–N1 HPV+ OPSCC treated with TORS and neck dissection. Adjuvant RT consisted of 50 Gy in 25 to the at-risk neck (and primary site when indicated), and low risk volumes and the contralateral neck received 45 Gy. The primary site was omitted in 52% of patients (pT1–T2, margins ≥2 mm, no LVI or PNI), while an optional SIB (52.5 to 50 Gy) was allowed for close or positive margins. Concurrent chemotherapy was given to 23%, and 52% were treated with proton therapy. At a median follow-up of 48 months, five-year LRC was 98.0% with no local failures and only two regional recurrences. Five-year OS was 92.6%. Notably, 33 high-risk patients with positive margins and/or >1 mm ENE had no locoregional failures. Only one patient required a feeding tube, grade 3 mucositis was 8%, and grade 3 dysphagia was <1%.
TBL: Long term follow up from this phase 2 study found that pushing the limits of de-intensified adjuvant radiation after TORS for oropharyngeal cancer had a low risk of locoregional failure and mild adverse effects. | Lukens, Int J Radiat Oncol Biol Phys 2026