TORS-Based Risk-Adapted De-Escalation Sustains 97% 5-Year OS in Early HPV-Positive Oropharyngeal Cancer

Transoral robotic surgery (TORS) followed by pathologic risk–stratified adjuvant therapy (observation n = 31, 50 Gy RT n = 15, or 56 Gy cisplatin-CRT n = 17) was evaluated in the single-arm Phase II SIRS trial (NCT02072148) of 63 molecularly confirmed early-stage HPV-OPC patients. After a 58-month median follow-up, 5-year OS reached 96.8% with disease-specific survival 100% and 5-year PFS 88.9%; only 5 patients (7.9%) recurred—all within two years and all salvaged—while two non-cancer deaths occurred. These survival metrics parallel the landmark E3311 risk-adapted TORS series (54-month PFS 90.6%, OS 95.3%) but were achieved with markedly less treatment intensity. Additionally, , even a “reduced-dose” approach of 60 Gy chemoradiation in the HN002 trial published in 2021 produced grade ≥3 acute toxicity in 79.6% of patients, demonstrating the potential of this methodology of treatment which spares patients from toxicity.