How strong is the evidence supporting our choice of primary treatment in Head&Neck Cancer? A recent review by Boonen et al. provides an interesting overview of the current clinical trial landscape, identifying 51 trials investigating TORS in head and neck oncology. Yet, despite this growing body of research, obtaining truly high-level evidence to guide the choice between primary surgery and radiotherapy remains remarkably difficult.
This is particularly relevant in HPV-positive oropharyngeal cancer.
We now talk extensively about treatment de-escalation. But there is something slightly misleading about the term. For years, HPV-positive patients have largely been treated according to treatment strategies developed for HPV-negative disease, and many have consequently experienced substantial long-term treatment-related morbidity. Perhaps what we call de-escalation is, at least partly, simply trying to stop over-treating patients whose disease biology we now understand better.
The trials reviewed by Boonen et al. show how TORS is increasingly being explored not only as an alternative to radiotherapy, but also as a platform for risk-adapted treatment and de-escalation, including biomarker-driven strategies.
The real challenge is therefore not simply to de-escalate treatment. It is to select the right treatment, for the right patient, from the beginning.
J Granell. Sep 5, 2026
Boonen A, Verstappen F, Nuyts S, Clement PM, Meulemans J, Di Santo D, Willaert R, van Mierlo A, Menten K, Vanclooster C, Neyt P, Vander Poorten V. Update on completed and ongoing trials investigating TORS in head and neck oncology. Front Oncol. 2026 Aug 18;16:1863731. doi: 10.3389/fonc.2026.1863731.