What is the diagnosis and treatment for oropharyngeal (throat) cancer?

From the Guidelines

For patients with oropharyngeal cancer, transoral robotic surgery (TORS) should be considered as a treatment option, especially for those with T1-T2 tumors and lateralized OPC, as it can provide a pathologically risk-adapted means to determine adjuvant therapy 1. When evaluating patients for TORS, a thorough history and physical examination by a multidisciplinary team, including fiberoptic laryngopharyngoscopy, should be performed to inform decision-making 1. Some key points to consider when evaluating patients for TORS include:

• A tissue biopsy should be performed to confirm the diagnosis, either through fine needle aspiration or core-needle biopsy of a clinically suspicious neck mass or biopsy of a suspected oropharyngeal primary tumor 1.
• High-risk HPV testing should be done routinely on biopsy of the primary site or lymph nodes 1.
• High-resolution cross-sectional imaging of the oropharynx and cervical lymphatics should be obtained either with contrast-enhanced CT of the neck or MRI 1.
• Evaluation of the chest with either a chest CT or PET-CT should be the next diagnostic step 1.
• Patients should have pretreatment speech and swallowing consultation, and evaluation of patient-reported outcomes and objective measurements using either modified barium swallow study or video-fluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing 1. It's also important to note that TORS is not recommended for tumors requiring a significant resection of the soft palate that might result in a functional deficit, or when there is clear radiologic and/or clinical exam evidence of extranodal extension or matted nodes 1. Additionally, TORS should not be offered as a treatment option for OPC in cases that have strong pretreatment indications for both postoperative radiation and chemotherapy 1. The most recent and highest quality study on this topic is from 2025, which provides guidance on the use of TORS in the multidisciplinary care of patients with oropharyngeal squamous cell carcinoma 1.

From the FDA Drug Label

In Combination with Radiation Therapy BONNER (NCT00004227) was a randomized, multicenter, controlled trial of 424 patients with locally or regionally advanced SCCHN Patients with Stage III/IV SCCHN of the oropharynx, hypopharynx, or larynx with no prior therapy were randomized (1:1) to receive either ERBITUX in combination with radiation therapy or radiation therapy alone Sixty percent of patients had oropharyngeal, 25% laryngeal, and 15% hypopharyngeal primary tumors; Efficacy results are presented in Table 8 Table 8: Efficacy Results in Locoregionally Advanced SCCHN in BONNER ERBITUX plus Radiation(n=211)Radiation Alone(n=213)Hazard Ratio(95% CIa)Stratified Log-rankp-value Locoregional Control Median duration (months) 24.4 14.9 0.68 (0.52–0.89) 0.005 Overall Survival Median duration (months) 49.0 29.3 0.74 (0.57–0.97) 0. 03

The cetuximab (ERBITUX) in combination with radiation therapy is effective for the treatment of oropharyngeal cancer, with a median duration of locoregional control of 24.4 months and a median overall survival of 49.0 months, as compared to radiation therapy alone, in patients with locally or regionally advanced SCCHN 2.

• Key findings:
  • Median duration of locoregional control: 24.4 months (ERBITUX plus radiation) vs 14.9 months (radiation alone)
  • Median overall survival: 49.0 months (ERBITUX plus radiation) vs 29.3 months (radiation alone)
• Population: Patients with Stage III/IV SCCHN of the oropharynx, hypopharynx, or larynx with no prior therapy.

From the Research

Oropharyngeal Cancer Treatment Options

• The treatment of oropharyngeal squamous cell carcinoma (OPSCC) can involve radiation therapy, surgery, or a combination of both, as stated in the study by 3.
• For early stage OPSCC, both surgery and radiotherapy can be effective as single treatment modalities, with equivalent locoregional control and survival rates, according to the study by 4.
• The choice of treatment modality depends on various factors, including the stage and location of the tumor, as well as the patient's overall health and preferences, as discussed in the study by 5.

Radiation Therapy for Oropharyngeal Cancer

• Radiation therapy can be used as a definitive treatment for OPSCC, especially for patients with stage IV and stage T3 N0-1 tumors, who should receive concurrent high-dose intermittent cisplatin, as recommended by the study by 3.
• Altered fractionation radiation therapy can be used for patients with stage IV and stage T3 N0-1 OPSCC who are ineligible for concurrent chemoradiation therapy, as suggested by the study by 3.

Surgery for Oropharyngeal Cancer

• Surgery can be an effective treatment option for early stage OPSCC, especially for patients with T1-2 and N0-1 tumors, who can undergo transoral surgical (TOS) resection of the primary tumor associated with selective neck dissection, as proposed by the study by 4.
• The use of sentinel lymph node biopsy can help select patients for surgery or radiation therapy, with patients having a positive sentinel lymph node being directed to upfront radiation, as suggested by the study by 6.

Comparison of Treatment Outcomes

• A multidimensional cross-sectional study found no statistically significant difference in quality of life, speech, swallowing, sleep, psychological distress, and nutritional status between patients treated with surgery or chemoradiation therapy, as reported by the study by 7.
• The study by 7 also found that both surgery and exclusive chemoradiotherapy can yield similar long-term outcomes across all evaluated dimensions.