Either radiation therapy or surgical resection is the most appropriate treatment for this patient with early stage squamous cell carcinoma of the oropharynx. Because head and neck cancers tend to recur locally rather than spread systemically, radiation therapy and surgical resection are the primary treatment modalities for stage I and II disease (without lymph node involvement) of the oropharynx. These tumors are highly curable with either modality, with the specific treatment typically selected based on factors such as surgical accessibility of the tumor and the expected morbidity and functional outcomes anticipated with either approach. In patients treated with surgery as the initial approach, adjuvant radiation or combined chemotherapy and radiation may also be indicated for follow-up treatment based on findings at surgery such as close or positive surgical margins, the presence of lymphovascular or perineural invasion, or identification of more advanced (T3 or T4) disease. An important exception to this general treatment approach for early stage head and neck squamous cell malignancies is nasopharyngeal cancer, which is treated with radiation alone for stage I disease and combined chemotherapy and radiation for stage II and higher disease because of a higher risk of distant disease occurrence with these tumors.

Because of their higher rate of locoregional recurrence, more locally advanced tumors (lymph node involvement) are usually treated with surgery (for accessible oral cavity tumors) or combined modality therapy (for other oropharyngeal anatomic sites) that includes radiation along with concurrent chemotherapy with a radiation sensitizer; cisplatin is the most commonly used agent for this purpose. Multiple studies have found that use of combined modality therapy results in significantly improved patient outcomes. However, treatment for locally advanced disease with cisplatin chemotherapy and radiation in this patient with early stage cancer would not be indicated.

Radiation therapy is considered definitive treatment for early stage head and neck cancer. Therefore, adjuvant chemotherapy following radiation therapy is not indicated and would not be an appropriate treatment in this patient.

Cetuximab, a monoclonal antibody directed against the epidermal growth factor receptor, also has an established role in the treatment of locally advanced squamous cell carcinoma of the head and neck when given with radiation therapy. The addition of either cisplatin or cetuximab has been shown to improve survival when compared with radiation therapy alone in patients with locally advanced disease. However, this is not the standard of care treatment for patients with early stage disease who have a much better prognosis and who can be effectively treated with either primary radiation therapy or surgery alone.