How would you manage p16+ SCC of the oropharynx with bulky lymph nodes that are not responding as expected to standard chemoradiation?

During treatment: Confirm via daily CBCT that the nodes in question remain inside PTV_high. If there are notable changes in external contour or target contour, have dosimetry run a verification plan to confirm coverage. This is particularly necessary if there is enlargement of the node in question, ...

Lack of rapid clinical response in the neck is pretty common in p16+ OPSCC, but the rate of residual disease after treatment is low (1). So as long as there isn't clear progression, we proceed with planned CRT and do not boost above 70 Gy.

Our routine response assessment is CECT of the neck and PET/C...