Would you omit postoperative radiation to the neck for a patient with advanced T-stage HNSCC and high risk features and bilateral pN0 neck dissection?

In general, if the neck has been operated on and the appropriate levels have been dissected, for all practical purposes it has been treated, and as such does not need to be irradiated. However, in practice, and based on historical practice patterns and consensus guidelines, the entire operative bed is treated regardless of pN status. This practice likely came for 2 reasons: Not all the appropriate levels were dissected, and/or the surgical technique "contaminated" this operative bed and seeded t...

I would feel comfortable omitting the neck radiotherapy in a bilateral pN0 neck at Washington University. Our surgeons and pathologists are very thorough, and I trust our team. Depending on the location of the tumor in the oral cavity, I would also want to see level Ia dissected. Having said that, just because of the patient demographics we commonly see, I would say that most of the patients I have used this approach on have been p16+ base of tongue tumors with negative margins where doing a nec...