In what N1 H&N patients, if any, would you consider treating the gross disease (primary + involved node) only without elective nodal radiation volume with definitive intent in order to reduce toxicity?

Madness. Not just no but bleep no. I don’t want to injure a lot of patients and discover something stupid.

Generally, we try to give patients the benefit of doubt and treat locally advanced disease with curative intent therapy. If one is uncomfortable with de-escalated elective volumes (we use 30 Gy for HPV-positive and 40 Gy for HPV-negative non-oral cavity disease), then this would be a reasonable situ...