Are there specific high riks features for which you would offer palliative adjuvant head and neck radiation in the setting of metastatic disease but without residual gross head/neck disease?

This question is worded in a confusing way. As I understand it, the scenario relates to a patient with both local and distant disease who is treated with chemotherapy and has a clinical complete response at the primary site. The question then is whether to add RT to the primary site.

We would do so ...

If a patient presents with disseminated disease both locally and distantly, I might consider a short course of radiation to the local area of disease in the head and neck, in particular if there is concern for compromise to the airway or for uncontrollable pain, etc. Following radiation, palliative ...