Would you recommend adjuvant radiation for a patient with head/neck merkel cell carcinoma following a pathologic complete response to neoadjuvant immunotherapy?

In CheckMate, after neoadjuvant IO and surgery, RT was recommended as part of care irrespective of response. Whether in patients with pCR, it added to the outcome is hard to say, as it was not randomized. We favor RT unless pre-IO disease was localized, small, and node negative.