As outlined above, TORPEdO used an exhaustive list of OARs including anatomic substructures like the supraglottic larynx, glottis, the superior, middle, and inferior pharyngeal constrictors, and the cricopharyngeal inlet. The planning goals for these were mean doses < 50 Gy for the superior and middle constrictors, 45 Gy for the glottis and supraglottic larynx, and a stingy 20 Gy for the inferior constrictors, cricopharyngeal inlet, and esophagus. Granted, PTV coverage was prioritized over these OARs. In the recent trial by Frank, et al., similar goals included glottic and supraglottic mean doses < 20 Gy and esophagus mean < 30 Gy. The oropharynx wasn’t subdivided like in TORPEdO, and goals included mean < 45 Gy, V50 <33%, and V60 <15%, none of which were mandatory. It would be interesting at some point to hopefully see a voxel based analysis of dose and adverse outcomes. | Thomson, Lancet 2026 and Frank, Lancet 2026
