Ferris RL, Flamand Y, Weinstein GS, et al. - In patients with intermediate-risk human papillomavirus–associated (HPV+) oropharynx cancer (OPC), outstanding oncologic outcome and favorable functional outcomes were conferred by primary transoral surgery (TOS) and reduced postoperative radiation therapy (RT).

• A phase II randomized trial wherein primary TOS and reduced postoperative RT was tested as a deintensification strategy in intermediate-risk HPV+ OPC.

• The criteria for considering TOS plus 50 Gy promising was: the lower limit of the exact 90% binomial confidence intervals should exceed 85%.

• TOS was performed for 495 patients, eligible and treated patients (n=359) were allocated to treatment arms.

• For arm A (observation), arm B (50 Gy), arm C (60 Gy), and arm D (66 Gy plus weekly cisplatin), the 2-year progression-free survival Kaplan-Meier estimate was 96.9%, 94.9%, 96.0%, and 90.7%, respectively.

• According to exploratory comparison, a trend toward better quality-of-life scores was evident in relation to reduced radiation therapy and chemotherapy.