Objective:

To summarize the available evidence and arguments relevant to decision-making between primary surgical and primary nonsurgical treatment approaches in patients with non-metastatic OPSCC.

Approach:

• Treatment Options Overview: Primary therapeutic options for non-metastatic OPSCC are divided into surgery-based and nonsurgical treatments, influenced by disease stage, tumor subsite, growth pattern, and patient-related factors.
• Guideline Recommendations: Clinical guidelines recommend various surgical and nonsurgical options for different stages of p16-negative and p16-positive disease without favoring any specific approach.
• Evidence Review: The review highlights the lack of large-scale, prospective, randomized Phase III trials comparing surgical and nonsurgical strategies for OPSCC.

Key Findings:

• No definitive optimal treatment approach exists for non-metastatic OPSCC due to insufficient comparative evidence from large-scale trials.
• The only randomized comparison for Stage III/IV non-metastatic head and neck cancer was terminated early, showing no significant survival differences.
• Early-stage OPSCC studies indicate no difference in progression-free survival and overall survival between surgery and radiotherapy.

Interpretation:

Decisions on treatment strategies should be personalized based on patient and disease-related factors, as well as institutional practices and resources.

Limitations:

• Lack of large-scale, prospective, randomized trials comparing treatment strategies.
• Previous studies had limited patient accrual and outdated treatment regimens.

Conclusion:

The review highlights the absence of definitive evidence favoring one treatment approach over another for non-metastatic OPSCC.

Sources:

• Clinical Guidelines
• EORTC 1420 Phase 3 Trial