## 3 Results
### Treatment  
All patients were treated with CRT either as definitive or adjuvant therapy. Concurrent chemotherapy agents included cisplatin 40 milligrams per meter squared (mg/m\({}^{2}\)) weekly, high dose cisplatin 100 mg/m\({}^{2}\) every 3 weeks, carboplatin AUC 2 weekly, cetuximab 400 mg/m\({}^{2}\) loading dose followed by 250 mg/m\({}^{2}\) weekly, and platinum/paclitaxel (carboplatin AUC 2 with paclitaxel 50 mg/m\({}^{2}\) weekly or cisplatin 20 mg/m\({}^{2}\) with paclitaxel 30 mg/m\({}^{2}\)) (Table 2). A small subset of patients (5 [10%] at the main campus vs. 2 [5%] at the satellite sites) were initially treated with induction chemotherapy (TPF-- docetaxel, cisplatin, and fluorouracil) followed by CRT with cisplatin, carboplatin, or cetuximab. Cisplatin was highly favored at the main campus (\(n=39\), 78%) with the rest receiving cetuximab (\(n=6\), 12%), carboplatin (\(n=4\), 8%), and carboplatin/paclitaxel (\(n=1\), 2%). In contrast, cisplatin and cetuximab use was equally distributed at the satellite sites (\(n=21\), 48% each), while the remaining two patients either received carboplatin or cisplatin/paclitaxel. Of the 60 cisplatin-treated patients, 58 (98%) received the recommended total minimum dose of 200 mg/m\({}^{2}\) with two patients (2%) receiving less due to prior surgical resection/physician's choice. All patients were treated with intensity modulated radiotherapy (IMRT) and the median radiation therapy dose was 68.8 Gray (Gy) (50 to 70 Gy) given at 2 Gy per fraction. A subset of patients at both sites (\(n=23\), 25%) underwent surgical resection with TORS prior to concurrent CRT. This subset of patients was subsequently treated with adjuvant CRT and given an average radiation dose of 65.3 Gy (50 to 66 Gy), as determined by pathologic risk features and performance status. Average length of radiotherapy treatment was 48 days at the main campus and 50 days at the satellite sites. Forty-nine (98%) patients at the main campus and 43 (98%) patients at the satellite sites completed their prescribed radiation therapy dose. Patients experienced common CRT effects as reported by the treating physician including mucositis, skin toxicities, hearing loss, neuropathy, nausea/vomiting, consistent with typical acute toxicities from CRT; however, proper grading of toxicity was not available except for weight loss (Table 2). Five patients at the main campus switched chemotherapy drugs from high-dose cisplatin to carboplatin or cetuximab, and two patients at the satellite sites switched from high dose cisplatin to carboplatin and from cetuximab to weekly cisplatin due to adverse symptoms secondary to the original  
Figure 1: (**A**) P16 breakdown and orophnx primary site breakdown in patient population and (**B**) T stage disease distribution by treatment site. chemotherapy. The reasons for chemotherapy drug switch included tinnitus, elevated creatinine, and azotemia. Overall, the chemotherapy dose was reduced by at least 20% in seven patients (four at the main campus vs. three at the satellite sites, \(p=0.83\)) treated with high-dose cisplatin (100 mg/m\({}^{2}\)) due to adverse symptoms. The number of patients who missed a therapy dose(s) or had chemotherapy treatment interruptions because of significant treatment-related adverse events (i.e., azotemia, leukopenia, neutropenia, thrombocytopenia), unplanned hospitalizations, or patient decisions were similar among the COH main campus and satellite groups (11 vs. nine patients, \(p=0.86\)). During the course of radiation therapy treatment, seven patients in the main campus and six patients in the satellite sites had treatment interruptions/breaks of at least two days. The reasons for treatment interruptions were related to severe weight loss (\(n=2\)), thus requiring another radiotherapy treatment planning computed tomography scan, toxicities secondary to treatment (\(n=7\)), insurance issues (\(n=1\)), patient's choice (\(n=1\)), and unplanned hospitalizations (\(n=2\)).