How do you approach postoperative radiation for small oral cavity cancers cases with limited risk factors?

LVI is considered a minor risk factor in HNC, similar to PNI, but data regarding its exact prognostic effect and whether it alone deserves adjuvant treatment are scant. For example, a large MSKCC of OC patients found LVI in only 11% of patients, compared with 25% of patients with PNI (Zaromi et al.,...

I have found that cases like this with only one or a few “minor” risk factors are some of the most challenging. Adjuvant therapy for oral cavity cancer is toxic, and first principles dictate that we should avoid treating patients who stand to derive no or limited benefit.

As Dr. @Dr. First Last point...

I usually don’t make exceptions, unless a patient is in very poor condition.

I have always approached decisions for adjuvant treatment as absolute or relative. ENE and margin issues have always been absolute, and for oral tongue, PNI to me is absolute as well, though some now are parsing extent similar to the skin where .1mm is considered concerning.

The remaining features,...