title: Primary surgery versus (chemo)radiotherapy in oropharyngeal cancer: the radiation oncologist's and medical oncologist's perspectives.
abstract: OBJECTIVE
  Radiotherapy is the traditional treatment for oropharyngeal cancer (OPC) because of its ability to preserve anatomic form and function compared with other conventional curative options. Recently, transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) have emerged prominently for T1-T2 OPC. This review summarizes the recent literature pertaining to OPC outcomes following primary TORS/TLM versus primary radiotherapy with or without chemotherapy and addresses controversies surrounding indications for adjuvant treatment following TORS/TLM.
  
  
  RESULTS
  Articles regarding OPC outcomes after primary TORS/TLM or radiotherapy/chemoradiotherapy published over the past 12 months were identified. TORS/TLM studies reported encouraging oncologic and functional outcomes. Primary radiotherapy alone showed exemplary results for a similar group of patients. However, comparisons of outcomes between these two primary modalities rely on historical data vulnerable to selection bias, even in a matched cohort study. The majority of cases treated with TORS/TLM also received adjuvant treatment. Soft tissue necrosis complicating this approach has also been reported. Controversies exist regarding the definition of resection margin status, prognostic value of extracapsular spread in human papillomavirus-related OPC and indications for adjuvant treatment following TORS/TLM.
  
  
  CONCLUSIONS
  TORS/TLM is an attractive approach for selected T1-T2 OPC, but its role should be refined based on a high level of evidence.
authors.affiliation: aDepartment of Radiation Oncology bDivision of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.forename: Aaron
authors.initials: A
authors.lastname: Hansen
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Rathod
authors.forename: Brian
authors.initials: B
authors.lastname: OʼSullivan
mesh_terms: D059248:Chemoradiotherapy; D006801:Humans; D053685:Laser Therapy; D008866:Microsurgery; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D065287:Robotic Surgical Procedures