On another note, It was shown in some studies that there is better outcome with a planned neck dissection, rather than a wait and and see approach. Around 30% of HNC, may be in the oropharynx, that needs salvage surgery, but may be more non HPV, but not all HPV responds positively, for unknown reasons, type B, smoking background possibly, and behaves aggressibelu like tobacco related. The key to survival is controlling the nodes. With oropharynx cancer, it's mostly regional, locoregional failure, not distant metasteses.