A Phase II Randomized Trial for Early-stage Squamous Cell Carcinoma of the Oropharynx: Radiotherapy vs Trans-oral Robotic Surgery (ORATOR)

Inclusion Criteria: * age 18 or older * willing to provide informed consent * ECOG performance status 0-2 * Histologically confirmed squamous cell carcinoma primary rumour site in the oropharynx (includes tonsil, soft palate, base of tongue, walls of oropharynx) * Tumour stage:T1 or T2, with likely negative resections at surgery * Nodal stage: N0, N1, or N2 (less than or equal to 4 cm in maximum dimension in any plane, on either side of the neck), without extranodal extension on pre-randomization imaging. * Patient assessed at head and neck multidisciplinary clinic (with assessment by radiation oncologist and surgeon) and presented at multidisciplinary tumour board prior to randomization. Exclusion Criteria: * Serious medical comorbidities or other contraindications to radiotherapy, chemotherapy or surgery * Prior history of head and neck cancer within 5 years * Prior head and neck radiation at any time * Metastatic disease * Inability to attend full course of radiotherapy or follow-up visits * Neck disease with unknown primary site * Prior invasive malignant disease unless disease-free for at least 5 years or more, with the exception of non-melanoma skin cancer * unable or unwilling to complete QoL questionnaires