For resected oral cavity squamous cell carcinoma with indication for adjuvant radiotherapy to the primary tumor bed, would you routinely include ipsilateral and/or contralateral nodes even with a pN0 elective neck dissection?

Since the question states "routinely", the short answer is yes, but the longer answer is there is much more nuance to this.

Some will say no based on Contreras et al., PMID 31246526.

It is important though to recognize that this paper is a bit more complex and the details are critical.

The question ref...

It depends on the quality of the neck dissection, the quality of the pathological evaluation, and DOI. For the first two, the issue is the number of nodes evaluated. A quality metric for a good neck dissection is the removal of ≥18 nodes in a hemineck. If DOI ≥5 mm, the risk of contralateral nodal m...

I don't think we are ready for complete omission of the pN0 neck, however, in cases with a well-lateralized tumor such as gingiva and oral tongue, I will omit a contralateral cN0 or pN0 neck. This has to be carefully considered on a case-by-case basis and involves discussion with the patient.

Yes, unless there’s a reason not to such as delayed healing.

We have been selectively omitting RT to the pN0 neck for the last few years at George Washington University, based on this study by Contreras et al., PMID 31246526. This is regardless of the risk factors at the primary tumor site. Additionally, if the ipsilateral neck RT is omitted due to pN0, we ha...