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Oropharyngeal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage III Oropharyngeal Cancer

The management of stage III carcinomas of the oropharynx is complex and requires multidisciplinary input to establish the optimal treatment.

Standard treatment options:

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  1. A combination of surgery with postoperative radiation therapy (PORT) or postoperative chemoradiation for selected high-risk patients.[1,2,3,4][Level of evidence: 1iiA]
  2. Altered fractionation radiation therapy yields a higher control rate and survival rate than standard fractionated radiation therapy only for patients with stage III cancer of the oropharynx.[5,6,7,8,9][Level of evidence: 1iiA]
  3. Concomitant radiation therapy with targeted agents. [10,11][Level of evidence: 1iiA]
  4. Concomitant chemoradiation therapy. [12,13,14,15][Level of evidence: 1iiA]

New surgical techniques for resection and reconstruction developed in the last 7 to 10 years that provide access and functional preservation have extended the surgical options. PORT is indicated based on pathological risk factors. High-risk features, including positive margins and extracapsular nodal extension, show additional locoregional control and survival benefit with the addition of concomitant chemotherapy.[1,2,3,4][Level of evidence: 1iiA] All of these patients may be considered for entry into neoadjuvant chemotherapy trials.

Specific surgical procedures and their modifications are not designated here because of the wide variety of surgical approaches to the area, the variety of opinions about the role of modified neck dissections, and the multiple reconstructive techniques that may give the same results. This group of patients should be managed by head and neck surgeons who are skilled in the multiple procedures available and actively and frequently involved in the care of these patients.

Surgery Followed by PORT or Chemoradiation Therapy

Postoperative chemoradiation therapy for oropharyngeal squamous cell carcinoma demonstrates a locoregional control and survival benefit compared with radiation therapy alone in patients who have extracapsular extension (ECE) of a lymph node or positive margins.[1,2,3,4][Level of evidence: 1iiA]

For patients with T3 and T4 disease (or stage III and stage IV disease), perineural infiltration, vascular embolisms, and clinically enlarged level IV or level V lymph nodes secondary to tumors arising in the oral cavity or oropharynx; two or more histopathologically involved lymph nodes without ECE; and close margins less than 5 mm, the addition of cisplatin chemotherapy given concurrently with PORT is unclear. The addition of cetuximab with radiation therapy in the postoperative setting for these risk factors is being tested in a randomized trial (RTOG-0920).

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