How do you manage patients with persistent/recurrent disease in the neck >6 months after receiving definitive chemo-RT for p16-negative oropharyngeal SCC?

Does your approach differ from p16 positive disease? Assuming a biopsy shows active disease and the metastatic workup is negative, when would you offer re-irradiation, either alone or after neck dissection? Which radiation modalities, dose, and fractionation do you typically employ? When is systemic therapy preferred?