How would you treat a patient with p16 (-) neck lymph node metastasis of an unknown primary, considering their history of prior supraclavicular and chest wall irradiation?

The management of SCCUP is complex and individualized and I would argue that the mitigation of risk is most important in a patient who may be considered for reRT. I would probably favor neck dissection and search for primary with biopsies and at least ipsi tonsillectomy (esp if the LN is in level 2)...