Intensity-Modulated Radiation Therapy and Chemotherapy in Treating Patients with Low-Risk HPV-Related Oropharyngeal Squamous Cell Carcinoma

Inclusion Criteria

• T0-3, N0 to N2c, M0 squamous cell carcinoma of the oropharynx
• Biopsy proven squamous cell carcinoma that is HPV and/or p16 positive
• =< 10 pack-years smoking history or =< 30 pack-years smoking history WITH >= 5 years abstinence from smoking
• Radiologic confirmation of the absence of hematogenous metastasis within 12 weeks prior to treatment; at a minimum, chest x-ray is required; CT imaging of the chest or PET/CT is acceptable
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• Platelets >= 100,000 cells/mm^3 (within 8 weeks prior to treatment)
• Hemoglobin >= 8.0 g/dl (within 8 weeks prior to treatment) (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable)
• Serum creatinine < 2.0 mg/dl (within 4 weeks prior to treatment)
• Total bilirubin < 2 x the institutional upper limit of normal (ULN) (within 4 weeks prior to treatment)
• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 3 x the institutional ULN (within 4 weeks prior to treatment) * Note that physician attestation of patient having no known history of liver disease can take the place of bilirubin and AST/ALT labs
• Negative serum pregnancy test within 2 weeks prior to treatment for women of childbearing potential
• Women of childbearing potential and male participants who are sexually active must practice adequate contraception during treatment and for 6 weeks following treatment
• Patients must be deemed able to comply with the treatment plan and follow-up schedule
• Patients must provide study specific informed consent prior to study entry

Exclusion Criteria

• Prior history of radiation therapy to the head and neck
• Prior history of head and neck cancer
• Unresectable disease (e.g. immobile node on physical exam, nodal disease that radiographically involves the carotid arteries, nerves)
• Currently taking disease modifying rheumatoid drugs (DMRDs)
• Severe, active co-morbidity, defined as follows: * Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months * Transmural myocardial infarction within the last 6 months * Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration * Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration * Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, coagulation parameters are not required for entry into this protocol * Pre-existing >= grade 2 neuropathy * Prior organ transplant * Systemic lupus * Psoriatic arthritis
• Known human immunodeficiency virus (HIV) positive; HIV positive patients are known to have worse clinical outcomes especially for local, regional, and distant cancer control; this poorer prognosis is thought to be secondary to a compromised immune system; thus, de-escalation of radiation and chemotherapy is not justifiable