A Canadian group has spent years promoting a de-escalation approach to HPV+ oropharyngeal squamous cell carcinoma that drops the radiation but embraces chemo. The treatment is termed NECTORS, short for NEoadjuvant Chemo (cisplatin + docetaxel x 3 cycles) before TORS and neck dissection, and is used for old-school stage III-IVA patients (cT3-4 and/or cN+). A prospective cohort of 67 patients treated with this approach demonstrated 3 regional recurrences at a median follow-up of 3.5 years. Quality of life assessments indicated a return to baseline or improvement from baseline at 24 months out from surgery. This is hypothesis generating, but far from clear how this approach fares compared to modern radiation or whether it’s generalizable outside this group. | Silver, JAMA Otolaryngol Head Neck Surg 2023
