Cancers of the head and neck are one of the most common cancers in India, with approximately 2,50,000 new cases detected annually. Approximately 40% of these cancers are oral cavity cancers. Oral cavity cancers have a strong epidemiology from exposure to tobacco and alcohol.

The first step after detecting a doubtful lesion in the oral cavity is a clinical examination followed by a pathological and radiological examination. This is generally followed by surgery to remove the primary tumor and the draining lymph nodes.The pathologist examines post-surgery, the removed lesion, and high-risk features are determined on examination, and a report is made. Based on the final report, Patients are advised to undergo radiation radiotherapy (RT) or chemoradiotherapy (CTRT) to remove the microscopic disease and prevent recurrences.

Current standard practices mandate the RT to be given to the primary tumor site and the draining lymph nodes,i.e., almost the entire neck region. Due to the high amount of radiation being given to the structures of the neck,this is associated with increased risk side effects such as difficulty in swallowing, painful swallowing, and food going into the lungs. Many patients (approximately 30-40%) require long durations of assisted swallowing to manage these complications by utilizing external food pipes passed through either the nose or directly put in the bowel. This severely affects the quality of life of patients.  Some studies report that to reduce these side  effects in patients with an adequate number of lymph nodal tissue removed with surgery,RT can be avoided to the neck nodal region in those patients where the surgically removed neck nodes do not show involvement by the cancer (pN0/pN1).

In this study, patients with oral cavity cancers of the buccal mucosa and well-lateralized tongue who have been treated surgically for the primary site and have undergone adequate neck dissection with a minimum of 18 lymph nodes removed and are pN0/pN1 are included. After discussion in the multidisciplinary joint clinic, RT is indicated after surgery, we will treat only the region of the primary tumor and nearby neck nodal regions at maximum risk of relapse. We will omit RT to the neck nodal regions with lesser chances of relapse.

This study will help us determine if RT to the uninvolved low risk nodal region is required after adequate surgery. This will also help us to know if sparing of these low-risk neck nodal regions is associated with a better side effect profile for these patients.