An otherwise healthy, non-smoker patient presents with a poorly differentiated oropharyngeal squamous cell carcinoma, p16+ (VPH+). As the tumour measures more than 4cm, it is a T3, but clinical examination suggests confinement to the tonsil: it is not fixed on palpation, anterior and posterior pillars are not involved, and there is no clinical suspicion that the tumour goes through the upper pharyngeal constrictor muscle. There is a massive enlarged ipsilateral node, but measuring less than 6cm, and another suspicious node identified through PET-CT imaging.
Therefore, it is staged as T3N1M0 (stage II) VPH+ poorly differentiated squamous cell carcinoma of the oropharynx (left tonsil). Should it be a VPH- tumour, it would have been staged as T3N2bM0 (stage IV). But it is HPV+.
Which are the treatment options? Which one would you advice? Let´s remember that the currently valid NCCN guideline is version 2.2023 (May 15, 2023).
Spoiler. ChatGPT recommends concurrent chemoradiation: “Based on the available evidence and the guidelines, a multimodal approach combining concurrent chemoradiation therapy is recommended as the primary treatment modality for this patient. This approach has demonstrated improved outcomes in OPSCC cases, particularly when combined with cisplatin-based chemotherapy. Surgery may be considered for salvage therapy if necessary. It is essential to consider the patient’s preferences, general health status, and potential treatment-related toxicities when making the final treatment decision.”
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