How do you treat a large, resected ex pleomorphic adenoma with unknown margin status due to tumor fragmentation?

Treat the tumor bed to 60-66Gy, no systemic therapy needed.

Follow and, if it recurs, resect and irradiate. Tumor spillage does not increase the risk of local recurrence for PA.

If the path is carcinoma ex pleo, would certainly offer PORT. Usually, a spill/tumor fragmentation does merit PORT consideration.

Spills involving the deep lobe are harder to salvage without impacting the nerve.

If it's a recurrent pleo w/o ca, it comes down to how confidently a salvage resection could be performed without impacting the facial nerve (assuming parotid location) in the event of a recurrence.

For high-grade tumors eg: carcinoma ex pleo, we treat the ipsilateral regional nodes.

For...

I agree that if carcinoma ex PA add postop RT.