Introduction: Rates of oropharyngeal squamous cell carcinoma have been on the rise in Australia for several decades.(1) In fact, it is now the most common mucosal head and neck cancer to be diagnosed in Queensland. (2). Definitive radiotherapy (RT) with or without concurrent cisplatin based chemotherapy is the contemporary standard of care in non-surgical, curative intent treatment of locoregionally advanced head and neck SCC.(2) However, RT is associated with significant post-treatment morbidity and mortality, and it is estimated that complications from RT arise in 4 to 37% of all patients. Methods: We conducted a retrospective cohort study of patients treated for oropharyngeal cancer at Fiona Stanley Hospital between January 2015 and December 2025 to determine the occurrence of soft tissue necrosis. Results: In univariate analysis, smoking history and tumour stage were significantly associated with soft tissue necrosis, with current or past smokers having higher odds of the complication. Other factors- including age, radiation dose, chemotherapy, subsite, p16 status, diabetes and anticoagulant use- were not significantly associated, and sparse event counts limited interpretation for some categorical variables. Conclusion: In conclusion, radiation induced soft tissue necrosis in oropharyngeal cancer patients is rare. In this cohort, smoking and advanced tumour stage appear to be associated with higher risk of developing necrosis, emphasising the need for careful monitoring in this group. 1.Fan KM, Sprague S, Zhang P, Ariyawardana A, Johnson NW. Rates of oropharyngeal cancer continue to rise steeply amongst Australian men. Oral Diseases. 2023;29(5):1959–66. 2.Gupta T, Maheshwari G, Gudi S, Chatterjee A, Phurailatpam R, Prabhash K, et al. Radiation necrosis of the bone, cartilage or cervical soft-tissues following definitive high-precision radio(chemo)therapy for head-neck cancer: an uncommon and under-reported phenomenon. The Journal of Laryngology & Otology. 2021;136(5):447–53.