Introduction | 17 1 In early-stage tumors (Stage I and II), localized and small tumors may be treated with either surgery or radiation therapy. Surgical options like transoral robotic surgery (TORS) or transoral laser microsurgery (TLM) aim to remove the tumor while preserving healthy surrounding tissue14. Alternatively, radiation therapy alone or combined with chemotherapy (chemoradiation) may be used, especially if surgery is not feasible or preferred by the patient. Surgery and radiation have shown to give similar outcomes, but different side-effects15. Early stage oropharyngeal carcinoma Early-stage oropharyngeal cancer, identified at stages I or II, signifies that the cancer is localized within the oropharynx without extensive spread to surrounding tissues or distant sites. Transoral minimally invasive surgery, may include different surgical techniques, most commonly transoral robotic surgery (TORS) or transoral laser surgery (TOLS). It presents a treatment option for early-stage oropharyngeal cancer that can precisely target and remove the tumor while minimizing damage to surrounding healthy tissues. This approach is particularly suited for patients whose tumors are located in areas accessible through the mouth, allowing for direct visualization and resection of the cancer16. Transoral surgery’s benefits include a potential reduction in the need for more invasive procedures, a lower risk of disfigurement, and, importantly, the preservation of organ function17,18. In the Netherlands it is most often used to avoid radiation if possible. However, when surgery results in too close or positive margins, or when more than very limited neck disease is present, adjuvant radiation therapy or even chemoradiation is necessary to eliminate any residual cancer cells and reduce recurrence risk. Radiation therapy remains a cornerstone in the management of early-stage oropharyngeal cancer, either as a primary treatment modality or adjuvant following surgery to address microscopic disease. Radiation therapy aims to eradicate cancer cells while preserving as much normal tissue as possible. However, it’s associated with toxicities such as dry mouth, dysphagia, and potential long-term changes in salivary function, underscoring the importance of careful treatment planning avoiding large fields and sparing critical structures19,20. Because of the side effects of radiotherapy and chemoradiation, de-intensification strategies for eligible patients are being studied widely21,22. Controversies persist in determining the optimal treatment approach, yet most researchers concur on one point: if a single modality proves effective, it should be favored over multimodality
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