5.

Treatment of locally advanced oropharyngeal cancer

Staging	Patient classification 1	Patient classification 2	Level I expert recommendation	Level II expert recommendation
Patients not suitable for surgery: poor physical condition, reject opreration for various reasons, or heavy tumor burden. Patients not appropriate for cisplatin treatment: age >70 years, performance status (PS) >2, loss of hearing, renal dysfunction (creatinine clearance <50 mL/min), or > level 1 neuropathy ( 11).
T1−2N1−2	Patients who meet criteria for surgery	Appropriate for cisplatin treatment	Surgery (1) (class 2A evidence) Radiation therapy + cisplatin (5) (class 1A evidence)	Radiation therapy + cetuximab (6,7) (class 1B evidence)
		Not appropriate for cisplatin treatment	Surgery (1) (class 2A evidence)	Radiation therapy + cetuximab (6,7) (class 1B evidence) Radiation therapy alone (1) (class 2A evidence)
	Patients who do not meet criteria for surgery	Appropriate for cisplatin treatment	Radiation therapy + cisplatin (5) (class 1A evidence)	Radiation therapy + cetuximab (6,7) (class 1B evidence)
		Not appropriate for cisplatin treatment	Radiation therapy alone (1) (class 2A evidence)	Radiation therapy + cetuximab (6,7) (class 1B evidence)
T3−4N0−3/ T1−2N3	—	Appropriate for cisplatin treatment	Radiation therapy + cisplatin (5) (class 1A evidence) Induction chemotherapy → radiation therapy alone (8-10) (class 1B evidence)	Radiation therapy + cetuximab (6,7) (class 1B evidence)
	—	Not appropriate for cisplatin treatment	Radiation therapy alone (1) (class 2A evidence)	Radiation therapy + cetuximab (6,7) (class 1B evidence)