Abstract Objective To investigate practice patterns in the treatment of p16‐negative/human papillomavirus (HPV)‐negative oropharyngeal squamous cell carcinoma (OPSCC) among members of the American Head and Neck Society (AHNS). Study Design Cross‐sectional. Setting Online electronic survey. Methods An online survey was distributed via AHNS survey system. Participation was voluntary, and data were anonymously collected. Results 108 members (7.7% of AHNS members) responded. Most (65.7%) had ≥5 years of experience in the field. Few practitioners (23.2% always and 10.2% frequently) confirmed HPV‐negative status with DNA/RNA in situ hybridization or PCR testing for p16‐negative tumors. Most surgeons (60.2%) reported recommending TORS for identification of an unknown primary in a patient with p16‐/HPV‐negative neck mass. Similarly, at least half (56.5%) of surgeons indicated always or frequently treating resectable T1‐T3 with TORS. The majority (73.2%) of surgeons indicated infrequently (59.3%) or never (13.9%) treating T3/T4 with traditional open surgery as first line. More than half of the surgeons (57.4%) believed survival is better with surgery compared to definitive nonsurgical therapy for HPV‐negative OPSCC. There was wide variation in the use of treatment intensification (dual modality adjuvant treatment for T1‐2N0, or tri‐modality treatment for T1‐T2N1), with 19.4% reporting never, 36.1% infrequently, 34.3% frequently, and 10.2% always doing so. Conclusions A majority of AHNS surgeons (57.4%) believe survival for HPV‐negative OPSCC is better with surgery. Most (56.5%) would treat resectable T1‐T3 tumors with TORS, while the minority (26.8%) would frequently or always operate on T3‐T4 tumors. There was wide variation in practice with respect to treatment intensifiication owing to remaining knowledge gaps in the field.
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