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Oropharynx SCC (p16/HPV−) — Definitive Treatment
Oropharynx SCC
p16 / HPV −
Early
T1–2 N0–1
Resection + ipsilateral /
bilateral neck dissection
single modality if pN0–1
Definitive RT
Concurrent chemoRT
(for T1–2 N1)
alternative
Resectable locally advanced
T3–4 · N2–3
Surgery + neck dissection
Neoadjuvant pembrolizumab
PD-L1 CPS ≥1, except N0 — KEYNOTE-689 ↗
Surgery → RT + pembrolizumab
(+ cisplatin if ECE / + margin)
→ adjuvant pembrolizumab
Definitive concurrent
chemoRT (cisplatin)
Adjuvant therapy
by pathologic risk
pN0, no adverse features
observe
pN1, no other risk
consider RT
Extranodal extension
± positive margin
chemoRT (cisplatin)
Positive margin
re-resect, or RT / chemoRT
Other risk features
RT ± concurrent chemo