Take the Road Less Treated

Consideration of ultrasound-guided core biopsy after initial negative fine needle aspiration (FNA) or upfront exam under anesthesia (EUA) for this initially unknown primary could have contributed to diagnosis in lieu of requiring a neck dissection. With neck disease known, we view American Joint Committee on Cancer (AJCC) seventh edition staging N2a disease and focal extranodal extension (ENE) as adverse pathology requiring adjuvant radiation therapy. We favor proceeding with definitive radiation therapy which may provide improved swallowing outcomes compared with transoral robotic surgery (TORS) as seen in the ORATOR (A Phase II Randomized Trial for Early-stage Squamous Cell Carcinoma of the Oropharynx: Radiotherapy vs Trans-oral Robotic Surgery) trials, particularly for this base of tongue (BOT) primary.