Well, my trailer is quite large & heavy. 24,500 # loaded with about 6000 pin weight. So, my Dodge was "bombed" to deal with this weight. Injectors, TST, PDR turbo, on and on (see sig). I also had to install air bags to account for the weight. With all these mods, I would get anywhere from 7. 5 to 8. 5 mpg running the speed limit (65 to 70 mph). The dodge had no trouble pulling hills, although I would have to back out of the throttle on long pulls due to high EGTs. I did feel like I was having to work it pretty hard, though. I would maintain over 20 psi boost practically all the time, even on the flats. I estimate my Dodge horsepower in the 450 hp range (based on a 92 mph trap speed at the drags last October). So I feel I had "enough" power. Empty, the Dodge would get a respectable 18 mpg.
The Volvo, on the other hand, gets 11. 9 empty, and has done as poorly as 8. 1, and as good as 9. 1 towing the trailer. I've only checked one tank empty, mainly because I hardly ever unhook from the trailer. I use the Dodge for my "running around town". The N14 in the Volvo has 500 hp and 1650 ft lbs torque. It truly doesn't act like it knows the trailer is there. I set the cruise on 70, and forget it. I've not encountered a hill that required a downshift yet. That said, I've not cross the rockies, or any other major mountain chain. Just long rolling hills in Texas and Southern NM.
I did drive a 2004 F-650 with the CAT the other day. Had a trailer very similar to mine hooked to it. It was pretty short on power in my opinion. 65 MPH was about all it had, plus it rode like a buckboard. No airride seats, and spring suspension on the axles. Very rough. The CATs are expensive to bomb, so I've heard. I think they're rated at 330 hp/860 tq. Like I said earlier, you give up a lot of this "extra" torque just to pull the extra 6,000 pounds of truck your driving around. That makes the extra 240 ft lbs over a Dodge 5. 9 basically "a wash. " I know a few folks that purchased Mediums only to have them move to an HD later. The Crew Cab FLs are very expensive, too.
Bottom line: There's no "perfect" truck that excels at everything. The Dodge was perfect for me initially, but as my family and towing needs have increased, it lacks some capacity (both people and load). In 2003 when I upsized my trailer, the Dodge proved to be a little weak in the britches from a suspension/duty standpoint. The medium dutys have their problems too, mainly low power (IMO). The HDs? Well that's where I'm at now, and I like it

but my wife won't even get behind the wheel. Maintenance and repairs are more costly, too. So there's no perfect truck out there. Some guys will disagree, but then again, there are guys that think towing a 8,000 travel trailer is really loaded!
Investigate all the options, and list the pros and cons of each. Each option will have its shortcomings. Then, make your choice based on which option has the fewest compromises for your given situation.
Good Luck.